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Found 51 results
  1. News Article
    A new study has found that the pandemic has severely affected people’s mental health and relationships all over the world, particularly for young adults. The third annual mental state of the world report (MSW) commissioned by Sapien Labs, a non-profit research organisation, conducted a global survey to better understand the state of mental health. The research compiled responses from over 400,000 participants across 64 countries, asking respondents about their family relationships, friendships and overall mental wellbeing. The survey found that there has been little recovery in declining mental health during the pandemic, which the group measures by a score called “mental health quotient”. It had found that average score had declined by 33 points – on a 300-point scale – over the past two years and still showed no signs of recovery, remaining at the same level as 2021. Read full story Source: The Guardian, 1 March 2023
  2. News Article
    Doctors at an east London hospital say they are seeing so many risky cases of laughing gas misuse that they have drawn up treatment guidelines for colleagues in the UK. Nitrous oxide, sold in metal canisters, is one of the most commonly used drugs by 16 to 24-year-olds. Heavy use can lead to a vitamin deficiency that damages nerves in the spinal cord. The Royal London Hospital team say medics need to be on alert. They have been seeing a new case almost every week. The guidelines, endorsed by the Association of British Neurologists and written with experts from Manchester, Birmingham, Nottingham and the Queen Mary University of London, warn doctors what to look for and how to treat. Read full story Source: BBC News, 23 February 2023
  3. News Article
    Police have carried out more than 5,500 investigations into patients who have been reported missing from NHS facilities in Scotland since 2019. The figures were outlined in a written response from Keith Brown, the justice secretary, to Jamie Greene, the Conservative MSP. Greene, who is the justice spokesman for the Conservatives, said the figures gave serious cause for concern. He said that the complete figure could be much higher because the data provided only included those reported to police. He urged Brown and Humza Yousaf, the health secretary, to provide adequate resources for policing and the health sector to ensure vulnerable patients were not slipping through the cracks. Greene said: “These figures are deeply alarming. Relatives expect their loved ones to be safe while they are staying, or being treated in, an NHS facility. It gives serious cause for concern that over 200 investigations have had to be launched in just the last few years to determine the whereabouts of young people who went missing from NHS grounds.” Read full story (paywalled) Source: The Times, 3 January 2023
  4. News Article
    One in four 17- to 19-year-olds in England had a probable mental disorder in 2022 – up from one in six in 2021, according to an NHS Digital report. Based on an online survey, rates among teenage boys and girls were similar – but twice as high in 17- to 24-year-old women compared with men. The charity Mind said the UK government "will be failing an entire generation unless it prioritises investment in young people's mental-health services". Matthew Rimmington, 24, is working full-time after studying acting at university, but aged 18, he felt his life was falling apart. It started with symptoms of anxiety, which deteriorated until his feelings really started scaring him. Despite going to his GP and being referred to NHS mental-health services, Matthew received no early support. "I was put on one waiting list and then another one," he says. "It was a constant back and forth and we never got anywhere." Mind interim chief executive officer Sophie Corlett said funding should be directed towards mental-health hubs for young people in England, where they can go when they first start to struggle with their mental health. "The earlier a young person gets support for their mental health, the more effective that support is likely to be," she said. "Young people and their families cannot be sidelined any longer by the government, who need to prioritise the crisis in youth mental health as a matter of national emergency." Read full story Source: BBC News, 29 November 2022
  5. News Article
    A growing number of children with mental health problems are being treated on adult psychiatric wards as services struggle to cope with a surge in demand following the pandemic, the NHS watchdog has warned. There were 249 admissions of under-18s to adult psychiatric wards in England in 2021-22, according to data provided by NHS trusts to the Care Quality Commission (CQC), up 30% on the year before. Of the children admitted to adult wards, 58% of cases were because the child needed to be admitted immediately for their safety. But in more than a quarter of cases, 27%, the child was admitted to the adult ward because there was no alternative child inpatient or community outreach service available. The findings come more than 15 years after the government set a target to end inappropriate admissions of children to adult psychiatric wards. The number of admissions gradually reduced but has now risen again, the CQC figures suggest. Dr Elaine Lockhart, chair of the Child and Adolescent Faculty at the Royal College of Psychiatrists, said the figures were “a concern but not a surprise. We’ve got a lot of children and young people who have become more unwell. Services are really struggling to meet their needs,” she said. Read full story Source: The Guardian, 30 October 2022
  6. News Article
    Some of the most senior gender identity specialists in the UK have accused their professional body of “contributing to an atmosphere of fear” around young people receiving gender-related healthcare. More than 40 clinical psychologists have signed an open letter to the Association of Clinical Psychologists UK in protest at the organisation’s recent position statement on the provision of services for gender-questioning children and young people. They say they believe there was a failure to properly consult experts in the field or service users, resulting in a “misleading” statement that “perpetuates damaging discourses about the work and gender-diverse identities more broadly”. About half of those signatories are current or former holders of senior roles – including the current director – at what was the only NHS gender identity service for children in England and Wales, the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS foundation trust in London. NHS England announced in July it would be closing the GIDS and replacing it with regional hubs, after being warned by the interim report of the Cass Review into gender services for young people that having only one provider was “not a safe or viable long-term option”. In 2021, inspectors rated the service “inadequate” overall and highlighted overwhelming caseloads, deficient record-keeping and poor leadership, suggesting that record waiting lists meant thousands of vulnerable young people were at risk of self-harm as they waited years for their first appointment. In a position statement published last month, the ACP-UK wrote that “the new, regional services will have to offer a radical alternative [after the closure of GIDS] to meet the needs of all young people with gender dysphoria.” The letter suggests: “An alternative interpretation is that it is possible to provide support for distress related to gender identity where mental health needs and neurodiversity are also present, and remain cognisant of all factors within formulation-based practice”. Read full story Source: The Guardian, 2 November 2022
  7. News Article
    The number of people under 40 in the UK being diagnosed with type 2 diabetes is rising at a faster pace than the over-40s, according to “shocking” and “incredibly troubling” data that experts say exposes the impact of soaring obesity levels. The UK ranks among the worst in Europe with the most overweight and obese adults, according to the World Health Organization. On obesity rates alone, the UK is third after Turkey and Malta. The growing numbers of overweight and obese children and young adults across the UK is now translating into an “alarming acceleration” in type 2 diabetes cases among those aged 18 to 39, analysis by Diabetes UK suggests. There is a close association between obesity and type 2 diabetes. There is a seven times greater risk of type 2 diabetes in obese people compared with those of healthy weight, and a threefold increase in risk for those just overweight. “This analysis confirms an incredibly troubling growing trend, underlining how serious health conditions related to obesity are becoming more and more prevalent in a younger demographic,” Chris Askew, the chief executive of Diabetes UK, said. He added: “While it’s important to remember that type 2 diabetes is a complex condition with multiple other risk factors, such as genetics, family history and ethnicity, these statistics should serve as a serious warning to policymakers and our NHS. “They mark a shift from what we’ve seen historically with type 2 diabetes and underline why we’ve been calling on the government to press ahead with evidence-based policies aimed at improving the health of our nation and addressing the stark health inequalities that exist in parts of the UK.” Read full story Source: The Guardian, 1 November 2022
  8. News Article
    Charities are warning that young cancer patients facing soaring living costs are in a "desperate" situation. Both Macmillan Cancer Support and Young Lives vs Cancer say they've seen dramatic increases in the number of people asking for emergency grants. Research suggests tens of thousands of 18 to 39-year-olds with cancer are struggling to pay basic living costs. Shell Rowe was among those who told BBC Newsbeat they're worried about becoming financially independent. She was diagnosed with stage four non-Hodgkin's lymphoma at age 20 in 2019, just as she was about to study film in California for her third year of university. "Prices have skyrocketed. I haven't been able to work and haven't been able to save and get a job," she says. "How am I ever going to be able to be financially independent? It really scares me." More than half of the 18 to 39-year-olds with cancer surveyed by Macmillan and Virgin Money said they needed more financial support to manage the rising cost of living. One in four young people are getting further into debt or have fallen behind paying rent and energy bills because of increased living costs, according to the survey of 2,000 people across all age groups. More than a tenth (11%) of those surveyed say they've had to delay or cancel medical appointments due to the rising cost of petrol. Many people have to travel long distances for treatment, often in their own cars or a taxi because the risk of infection rules out taking public transport. "It's never been as bad as this. Young people with cancer are in really desperate circumstances, because of the cost-of-living crisis," says Rachel Kirby, chief executive of Young Lives vs Cancer. "No young cancer patient should have to think about the choice of putting fuel in the car to get to treatment, or whether they can heat their homes. But those are the kinds of situations they're facing," Read full story Source: BBC News, 3 October 2022
  9. Content Article
    Key points The report highlights the following key findings about children and young people's mental health: One in six children aged 6 to 16 were identified as having a probable mental health problem in July 2021, a huge increase from one in nine in 2017. Boys aged 6 to 10 are more likely to have a probable mental disorder than girls, but in 17 to 19-year-olds this pattern reverses, with rates higher in young women than young men. By the age of eight, 7 in 10 children report at least one adverse childhood experience (ACE).Three in four adolescents exposed to ACEs develop mental health problems by the age of 18, including major depression, conduct disorder, alcohol dependence, self harm, suicide attempts, and posttraumatic stress disorders (PTSD). In 2018, the suicide rate in women aged under 25 years had significantly increased since 2012 to its highest ever recorded level of 3.3 per 100,000. Nearly half of 17–19-year-olds with a diagnosable mental health disorder have selfharmed or attempted suicide at some point, rising to 53% for young women. In 2018-19, 24% of 17-year-olds reported having self-harmed in the previous year, and seven percent reported having self-harmed with suicidal intent at some point in their lives. 16% reported high levels of psychological distress. There was a 47% increase in the number of new emergency referrals to crisis care teams in under-18-year-olds between December 2019 and April 2021. Consistent findings showing people in marginalised groups are at greater risk of mental health problems, including people from Black, Asian and other minority ethnic backgrounds, lesbian, gay, bisexual and transgender people, disabled people and people who have had contact with the criminal justice system, among others. Recommendations A commitment from the next Prime Minister to fund an immediate £1bn children and young people’s mental health wellbeing recovery programme to improve the quality and effectiveness of mental health care and support, with guaranteed appointment and treatment times as part of a wider post pandemic commitment to children and young people. New local frameworks for children and young people’s wellbeing (aged 0-25) between health, children’s services, schools, youth offending teams and the police to provide an integrated approach with common performance targets and pooled financial contributions from all partners. Guaranteed mental health assessments for children and young people at points of vulnerability. This would mean an automatic assessment and guaranteed mental health package for children entering care and automatic assessments for children and young people at risk of exclusion from school, who go missing, at the point of arrest, or are involved in violence or crime. It would include a guarantee of assessment by education psychologists for any child at risk of exclusion. A national implementation programme to embed a whole school and college approach to mental health and wellbeing across all education settings in the country. This should include a commitment from Government to provide a funding package for Mental Health Support Teams beyond 2023/24 to ensure that all schools have access to this vital additional support by 2030. An ambitious programme of drop in mental health hubs delivered in the community. These new community drop-in centres will provide vital drop in access and work with local community groups to provide outreach support, funded by the new recovery programme. A national ‘Programmes on Prescription’ scheme in every area. Building on emerging local approaches, the roll out of a major funded programme of social prescribing for mental health wellbeing that enables GPs and health professionals to pay for sports and arts sessions, music, drama, activities, youth clubs, outings, and volunteering programmes to improve young people’s confidence, self-esteem, and skills and make friends. A major recruitment programme with ambitious targets to build the children and young people workforce required to meet this expansion of services. It is vitally important to ensure that this workforce is diverse and culturally competent. Wellbeing and mental health training and support for all professionals working with children and young people. Identifying and understanding the mental health needs of children is vital if they are to be offered the help they need. Make co-production and community work a cornerstone of mental health care to ensure long-term trusted relationships for young people and to give them a constant point of contact. Improved wellbeing on digital platforms. We know that many children feel more comfortable and sometimes prefer help online, which should also be extended and supported as an important strand of a local strategy. Better information and support for parents to support children and young people’s positive mental health and wellbeing. Improving the mental health and well-being of young people at risk of harm and being involved in the criminal justice system. This should be measured as a core aspect of NHS equality targets with leadership, resources, and delivery plans.
  10. Content Article
    Coroner's Matters of Concern The concern in this case is that a vulnerable young person can be known to the County Council and Mental Health Trust and yet not receive the support they need pending substantive treatment. Danny was repeatedly assessed as not meeting the criteria for urgent intervention and yet the waiting list for psychological therapy was likely to be over a year from point of first presentation. That gap between urgent and non-urgent services is potentially dangerous for a vulnerable young person, where there is a chronic risk of an impulsive act. Although I understand that there is a long term plan to extend young people’s services to age 25, but I remain concerned about the ongoing situation, and that a young person today could be faced with the same challenges in finding support pending substantive treatment. I believe this concern is the combined responsibility of Cambridgeshire County Council and CPFT. These organisations may wish to consult in preparing their response to this report. The inquest heard evidence about the considerable delay in obtaining appointments for the Gender Identity Clinic, and about the shortage of availability for psychological therapies such as CBT. These are matters for policy and funding. This report will therefore be copied to NHSE and The Secretary of State for Health for information purposes only.
  11. News Article
    A catalogue of failures among prison and health professionals has been highlighted in an investigation report into the death of a teenager’s baby after she gave birth alone in her cell at the largest women’s prison in Europe. The Prisons and Probation Ombudsman published the devastating report into the events in September 2019 at HMP Bronzefield in Ashford, Middlesex on Wednesday. The case was first revealed by the Guardian and the baby’s death triggered 11 separate inquiries. The report details a disturbing series of events that culminated with the young woman, who cannot be named, being in “constant pain” on the night of 26 September and eventually passing out while giving birth. According to the report the teenager "appeared to have been regarded as difficult and having a ‘bad attitude’ rather than as a vulnerable 18-year-old, frightened that her baby would be taken away”. Failings included: There was confusion among different health professionals about her due date. The day before her baby was born she told a prison nurse she would kill herself or someone else if the baby was taken away from her, but this information was not adequately shared. On 26 September she was put on extended observation, meaning she should have been regularly checked but this did not happen. She rang the bell twice at 8.07pm and 8.32pm that day. A call was connected then immediately disconnected at 8.45pm. She did not press the bell again. Checks by prison officers at 9.27pm and 4.19am revealed “nothing untoward”. It was left to two prisoners to alert staff to the fact that there was blood in her cell at 8.21am on 27 September. Prisons and Probation ombudsman Sue McAllister said: “Ms A gave birth alone in her cell overnight without medical assistance. This should never have happened. Overall, the healthcare offered to Ms A in Bronzefield was not equivalent to that she could have expected in the community.” The publication of the report has triggered multiple calls for an end to the imprisonment of pregnant women from the Royal College of Midwives, NGOs and academics in the field. Read full story Source: The Guardian, 22 September 2021
  12. News Article
    The UK's vaccine advisory body has decided not to recommend vaccines for healthy 12-15-year-olds, but it will offer vaccines to thousands more children with underlying health problems. Ministers will now seek more advice on extending the rollout based on factors such as school disruption. There is general agreement that this was a really tricky call to make. Bur The Joint Committee on Vaccination and Immunisation (JCVI) has focused squarely on the health benefits of vaccination to children themselves - not on the impact to their schooling or other people. Children's risk from Covid isn't zero but the chances of them becoming seriously ill from Covid are incredibly small. Deaths among healthy children are extremely rare - most have life-limiting health conditions. That means there needs to be a clear and obvious advantage to giving them a jab. However, a very rare side-effect of the Pfizer and Moderna vaccines has made that calculation a lot more complicated. Paul Hunter, professor of medicine at University of East Anglia, says there's been intense pressure on the JCVI and he can understand why they are being cautious. "I don't know what the answer is - I'm very close to the fence on this. There's not enough data to be absolutely certain." Read full story Source: BBC News, 4 September 2021
  13. News Article
    A father whose son took his own life in July 2020 is calling for an "urgent overhaul" of the way some counsellors and therapists assess suicide risk. His son Tom had died a day after being judged "low risk", in a final counselling session, Philip Pirie said. A group of charities has written to the health secretary, saying the use of a checklist-type questionnaire to predict suicide risk is "fundamentally flawed". The government says it is now drawing up a new suicide-prevention strategy. According to the latest official data, 6,211 people in the UK killed themselves in 2020. It is the most common cause of death in 20-34-year-olds. And of the 17 people each day, on average, who kill themselves, five are in touch with mental health services and four of those five are assessed as "low" or "no risk", campaigners say. Tom Pirie, a young teacher from Fulham, west London, had been receiving help for mental-health issues. He had repeatedly told counsellors about his suicidal thoughts - but the day before he had killed himself, a psychotherapist had judged him low risk, his father said. Tom's assessment had been based on "inadequate" questionnaires widely used despite guidelines saying they should not be to predict suicidal behaviour, Philip said. The checklists, which differ depending on the clinicians and NHS trusts involved, typically ask patients questions about their mental health, such as "Do you have suicidal thoughts?" or "Do you have suicidal intentions?" At the end of the session, a score can be generated - placing the individual at low, medium or high risk of suicide, or rating the danger on a scale between 1 and 10. Read full story Source: BBC News, 20 April 2022
  14. News Article
    There is no evidence that Covid vaccines have led to an increase in deaths in young people, the Office for National Statistics (ONS) has said. Six months after the mass rollout of Covid vaccines, medical regulators started to report slightly higher rates of two heart conditions after receiving the Pfizer and Moderna jabs. Myocarditis is an inflammation of the heart muscle itself, while pericarditis is inflammation of the fluid-filled sac the heart sits in. Both side effects are very rare but appear to be more common after a second dose of either Covid jab, particularly in younger men. The ONS looked at outcomes shortly after vaccination, when the risk of any side effect is highest. The chance of a young person dying in that time was no different to later periods the researchers looked at. Julie Stanborough, deputy director at the ONS said: "We have found no evidence of an increased risk of cardiac death in young people following Covid-19 vaccination." Read full story Source: BBC News, 22 March 2022
  15. News Article
    The death of a "vulnerable" transgender teenager who struggled to get help was preventable, a coroner has said. Daniel France, 17, was known to Cambridgeshire County Council and Cambridgeshire and Peterborough Foundation Trust (CPFT) when he took his own life on 3 April 2020. The coroner said his death showed a "dangerous gap" between services. When he died, Mr France was in the process of being transferred from children and adolescent mental health services (CAMHS) in Suffolk to adult services in Cambridgeshire. The First Response Service, which provides help for people experiencing a mental health crisis, also assessed Mr France but he had been considered not in need of urgent intervention, the coroner's report said. Cambridgeshire County Council had received two safeguarding referrals for Daniel, in October 2019 and January 2020, but had closed both. "It was accepted that the decision to close both referrals was incorrect", Mr Barlow said in his report. Mr Barlow wrote in his report, sent to both the council and CPFT: "My concern in this case is that a vulnerable young person can be known to the county council and [the] mental health trust and yet not receive the support they need pending substantive treatment." He highlighted Daniel was "repeatedly assessed as not meeting the criteria for urgent intervention" but that waiting lists for phycological therapy could mean more than a year between asking for help and being given it. "That gap between urgent and non-urgent services is potentially dangerous for a vulnerable young person, where there is a chronic risk of an impulsive act," Mr Barlow said. Read full story Source: BBC News, 25 February 2022
  16. News Article
    Campaigners have called for a change in how epilepsy services are delivered after "alarming" new research revealed that nearly 80% cent of deaths in young adults could have been avoided. It comes as researchers behind the first ever national review into deaths linked to the condition warned that "little has improved in epilepsy care" despite previous findings of premature mortality. They describe the situation as a "major public health problem in Scotland", adding that deaths "are not reducing, people are dying young, and many deaths are potentially avoidable”. In particular, the Edinburgh University team found that adults aged 16 to 24 were five times more likely to die compared to the general population, a problem they said may be linked to the "vulnerable period of transition from paediatric to adult care". Overall, for adults with epilepsy aged 16 to 54, the mortality rate was more than double that for the age group as a whole, with as many as 76% of these deaths potentially preventable and the majority occurring among patients from the most deprived areas. Read full story Source: The Herald, 11 November 2021
  17. News Article
    England's first women's health ambassador is calling for "one-stop shops" where women can sort out their health needs. Dame Lesley Regan, also a practising doctor, wants to make it easier for women and girls to access care such as contraception and smear tests in the community. Her new role aims to close the "gender health gap". She will also support the upcoming government-led women's-health strategy. "At the moment, we waste a lot of resource in telling girls and women that they cannot have things," she told BBC News. "So you might go off to your doctor or gynaecologist or heart specialist and get told, well, you cannot have a smear here, even if it is due, or you need to go somewhere else for this, that and the other. "We should make it very, very easy for people to access this out in the community - why do you need to go to a secondary or tertiary facility for things that are very easy to provide?" Instead, she wants health hubs where women could "go for half a day and get all these things sorted out" and then get on with their lives. "A one-stop shop is what I want for myself and what I want for my daughters and I'm sure it is what every other girl and woman wants and what every man and boy wants for the women in their lives, to be looked after that way," Dame Lesley said. Read full story Source: BBC News, 17 June 2022
  18. Content Article
    Aminata* didn’t plan to become pregnant at 15. When her mum died, she was sent to live with her aunty in the country’s capital city, Freetown, and felt from the outset that she was not welcome. Her cousins were attending school but there was no money to send Aminata, and instead she was expected to fetch water for the household every day, often spending four or five hours in the queue. When Patrick, one of the men who ran the pump, asked her to be his girlfriend, saying she could jump the water queue and he would also pay her school fees, she felt that she could finally get back on track. No-one had ever talked to Aminata about sex, contraception or pregnancy, and when she missed her period she was just pleased not to have to bother her aunty for sanitary pads which always made her feel like a burden. She discovered she was pregnant one evening several months later when her aunty noticed her changing body and confronted her, screaming that she had disgraced the family and would have to leave. Her few belongings were thrown into the street and she was on her own again. Patrick had told her he loved her, and she was sure he would be happy, so she climbed the hill to the water pump to tell him the news, only to be told he had already heard and left Freetown earlier in the day with no explanation. Knowing there was nowhere else for her to go, Aminata asked her cousin if she could sleep in his car, where she lay down and cried. The months that followed saw her finding different places to sleep - an empty market stall, a friend’s floor, an abandoned building. She would eat meals here and there in exchange for carrying water, washing pots and occasionally having sex with men she barely knew, who took advantage of her desperation. When she went into labour at eight months, Aminata was anaemic, malnourished and had a sexually transmitted infection. By the time she was taken to the hospital by a neighbour of her aunt’s, her baby was already dead and she was bleeding heavily. The 500ml of blood that she lost would hardly be noticed by a healthy, nourished woman, but for Aminata it was catastrophic. In a culture where blood is donated in an emergency by a relative, Aminata had no options and no money to pay, and died that night with her unborn baby. This is a true story, but it is not a story about just one girl; it describes the experiences of many pregnant girls in Sierra Leone. I lived in Freetown from 2001 to 2004, working with Lifeline Nehemiah Projects with children affected by the 10 year civil war, so was only too aware of the statistics that make Sierra Leone one of the most dangerous places to give birth. I saw the issues the young people we were supporting faced as they started to have their own families. A survey we did in 2015 in Eastern Freetown showed a 1 in 10 incidence of maternal death for girls becoming pregnant under the age of 18—in the UK the figure is 1 in 10,000. There are many reasons for this high death rate. Upstream social determinants such as poverty, gendered social norms, sexual coercion and stigma mean that girls have little agency with their sexual and reproductive lives, and once pregnant they are almost always thrown out of home and struggle to eat regularly or prepare for birth. Disrespectful care at health facilities means that they often do not take up antenatal care and are at very high risk of death from anaemia, bleeding, eclampsia, infections and prolonged labour leading to fistula.[1] I got together with my friend Mangenda Kamara, a gender studies specialist who lives in Freetown, and we looked at what we could do to help these girls. We realised that what they needed was a supportive, consistent adult to make sure they were safe and able to access maternity care as well as having the means to eat well in pregnancy and provide for their babies. We developed 2YoungLives as a simple, scalable, sustainable solution to this intractable issue. It is a mentoring scheme which pairs women known for kindness and compassion with three vulnerable pregnant girls. The project provides the girls with money to start a small business which the mentor supports them to run, allowing them to eat well in pregnancy. As a ‘loving aunty’, the mentor helps the girls to register for antenatal clinic, going with them for check-ups and being a birth partner when the girls go into labour. She provides emotional support, and gathers the girls to eat together, encouraging peer friendships. After birth, the mentor continues to support each girl, not taking over but being available if there are problems with breastfeeding, if she needs a few hours of sleep after a bad night, or if the baby is not well, encouraging timely care-seeking and ensuring the baby gets all immunisations. The mentors also promote postnatal contraception, reducing the risk of a second teenage pregnancy with its associated compounded risks. Since we started with our first team of four mentors in 2017, we have grown steadily to six teams—24 mentors in all—in urban, peri-urban and rural districts. We have seen great success in reducing the risk of maternal and neonatal death. Since 2017, the project has mentored over 200 girls; we have had no maternal deaths and a much-reduced rate of stillbirth and neonatal death. In addition, an education bursary grant from King’s College London in 2021 has allowed many girls to return to school or attend vocational training; some are now fully qualified plumbers and electricians. 2YoungLives is now part of an NIHR-funded Global Health Group, a partnership between King’s College London, the Sierra Leone Ministry of Health and Sanitation, Lifeline Nehemiah Projects (the Sierra Leone-based organisation that runs 2YoungLives), Welbodi Partnership and the University of Sierra Leone, and we are about to double our provision by starting a cluster-randomised feasibility trial in six new sites. There is a high level of buy-in from stakeholders—from local chiefs and women’s leaders to Ministry of Health representatives—as tackling teenage pregnancy, child marriage and maternal mortality are all highly prioritised policy areas in Sierra Leone.[2] 2YoungLives improves patient safety by seeing these young women not simply as ‘patients’ on the isolated occasions when they attend the clinic or come in to give birth, but by addressing the social determinants of maternal health and death. Our mentors provide the most basic of protective factors: a relationship with a caring adult. As a result of our mentors' support, the young women we work with are thriving, not just surviving. You can read more about 2YoungLives and how to support its work on the 2YoungLives website. *not her real name References 1 November L, Sandall J. ‘Just because she’s young, it doesn’t mean she has to die’: exploring the contributing factors to high maternal mortality in adolescents in Eastern Freetown; a qualitative study. Reproductive Health. 21 February 2018 2 Palathingal A. National strategy for the reduction of adolescent pregnancy and child marriage 2018-2022. United Nations Population Fund Sierra Leone. 2018
  19. Content Article
    What’s the worst thing you have ever seen? For those that work on the frontline in healthcare you may have heard this question asked many times… usually by friends or people you meet when you are trying to relax outside of work. They often want to hear some awful blood and guts story, something unusual being stuck in an unfortunate person’s orifice or a heroic story of a dramatic rescue. We all have something to tell along these lines. Especially when you work in ED, like me. Yep, they are awful episodes, especially for those involved, these awful stories often happen in ED. Car crashes, trauma, cardiac arrests, injured, sick children… you name it, I’ve probably seen it. When tragic things happen, we have support to get us through them. We have support from our wonderful work colleagues who understand – most of the time black humour gets us through. I want to tell you about the worst thing I ever saw, I still see, we all still see. It wasn’t a one off, I didn’t get any support, we didn’t get any support. In fact, it went unnoticed and it happened multiple times and often for hours on end. It’s like being in a recurrent bad dream, the trouble is that it isn’t a dream. It’s real and it's probably happening in hospitals up and down the country today. Rose tinted spectacles… It’s a Tuesday afternoon. It’s a warm, sunny day. I have had 2 whole days off. I’m rested and ready for the day ahead. I drive to work in a good mood. Today is going to be a great day. I walk up to the ED entrance. My hopes of a good day are dashed. There are already eight ambulances outside. I hear the sirens of another in the distance coming up the road. Perhaps the department was already empty… it might not be that bad? I step inside. Two paramedics wheel an elderly man up to the desk. He looks frail, he has a bruised face and blood running from his nose. He looks frightened. He has fallen in his rest home. "… you will have to park him in the corridor, love..." The corridor is now an ‘area’ in our ED. It’s not a walkway between two clinical areas, it’s now clinical area itself. We even have allocated a ‘corridor nurse’ to care for this group of patients. The corridor is full. Each side of the corridor there are people. People on trollies, in chairs, in wheelchairs. I feel their eyes staring at me. Someone is calling out for water, someone has vomited on the floor, an elderly lady is wandering around with her hospital gown on, it's not done up properly and everyone can see her bottom. Every few steps I take I hear someone ask when they are going to be seen. I see a couple crying, trying to console each other in full view of the onlooking people who have nothing else to do but wait. I must walk down to get to the staff room to start my shift. I feel like I am running the gauntlet. I need to get changed and get on with moving people out of the department. I hear staff members muttering "thank god the day staff are here" and "good luck, you’re going to need it". Ok, If I was able to nurse the way I have been taught; ensuring patients are listened to, made comfortable, had medication on time, are given food and water, turned if required, clean… basic nursing care, maybe I wouldn’t feel as crap as I do when I go home. Maybe I’m in the wrong job? But… this type of nursing takes time. Time is forever ticking, especially in ED. It's all about flow. Get them seen, treated and moved – within 12 hours. Sounds a long time 12 hours, doesn’t it? It’s not in healthcare. Blink, 12 hours have gone in a flash. Site managers constantly circle the nurses’ station with their clip boards, trying to strategically place patients on appropriate wards. Single sexed bays, side room, isolation rooms, monitored beds, surgical, medical, trauma, elective, the list goes on. It must be like playing one of those online strategy games, but it never ends. I’m now waiting for handover. The noise is deafening. White noise. I try and block out other people’s instructions, conversations, phones ringing, doors banging. My senses are overloaded. Not only is it too loud, the smell of stale alcohol and vomit is left in the air from an overdose that came in earlier, the irony smell of blood left by lady with a bleeding ulcer, the heat of the corridor and a hint of pseudomonas from a leaking leg ulcer – there are no windows here to give us any relief. This is my next 12 hours. People who are wearing lanyards appear. I see them when things go ‘tits up’. No idea who they are, what they do or where they come from. Never have they spoken to me and I have never seen them speak to a patient. They arrive in immaculate clothing and smell fresh, whereas I have been here a few hours and already blended in with the current smells. They are obsessed with how long people have stayed in the department. I see them frown and start talking to the site managers, who then speak to our nurse in charge, who then will speak to me. "We need to move X number of patients out of here in the next 2 hours." So, if I choose to help a man who may have soiled himself – this may take up to 40 minutes. That’s too long. I should have been preparing my patients to move off. But then if I don’t help him, the ward he moves onto will report me. Notes to prepare, IV antibiotics to give with in 1 hour, comfort rounds every 2 hours, mouth care, turn charts, feeding regimes, safety documentation to be completed, toileting, venepuncture, sepsis pathways, NEWS charting, escalation protocols… so many targets to be met. I can’t do this. It’s impossible. ‘The standard you walk past is the standard you accept’ Every time I walk down that corridor – I say this in my head. I have failed. We have failed our patients. That is the worst thing I have ever seen.
  20. Content Article
    So, what does it feel like working in chronically depleted staffing levels? "We are down three nurses today" – this is what I usually hear when I turn up for a shift. It has become the norm. We work below our template, usually daily, so much so that when we are fully staffed, we are expected to work on other wards that are ‘three nurses down’. Not an uncommon occurrence to hear at handover on a busy 50-bedded medical ward. No one seems to bat an eyelid; you may see people sink into their seat, roll their eyes or sigh, but this is work as usual. ‘Three nurses down’ has been the norm for months here, staff here have adapted to taking up the slack. Instead of taking a bay of six patients, the side rooms are added on making the ratio 1:9 or sometimes 1:10, especially at night. This splitting up the workload has become common practice on many wards. "That was a good shift" – no one died when they were not supposed to, I gave the medications, I documented care that we gave, I filled out all the paperwork that I am supposed to, I completed the safety checklists. Sounds a good shift? Thinking of Erik Hollnagel’s ‘work as done, work as imagined’ (Wears, Hollnagel & Braithwaite, 2015) – this shift on paper looks as if it was a ‘good shift’ but in fact: Medications were given late; some were not given at all as the pharmacy order went out late because we had a patient that fell. Care that was given was documented – most of the personal care is undertaken by the healthcare assistants (HCA) now and verbally handed over during the day – bowel movements, mobility, hygiene, mouth care, nutrition and hydration. As a nurse, I should be involved in these important aspects of my patients’ care, but I am on the phone sorting out Bed 3’s discharge home, calling the bank office to cover sickness, attending to a complaint by a relative. It’s being attended to by the HCA – so it's sorted? I have documented, probably over documented which has made me late home. I’m fearful of being reprimanded for the fall my patient had earlier on. This will be investigated and they will find out using my documentation what happened. The safety checklists have been completed for all my patients; comfort rounds, mouth care, falls proforma, bed rails assessment, nutritional score, cannular care plan, catheter care plan, delirium score, swallow test, capacity test, pre op assessments, pre op checklists, safe ward round checklist, NEWS charting, fluid balance charting and stool charting… the list is endless. Management have made things easier with the checklist ‘if it’s not written down it didn’t happen’ so now we can ‘tick’ against the check list rather than writing copious notes. However, I cut corners to enable me to complete all my tasks, some ticks are just ‘ticks’ when no work has been completed. No one would know this shift would they? What looks as if it has been a ‘good shift’ for the nurse, has often been the opposite for the patients and their family. There is a large body of research showing that low nurse staffing levels are associated with a range of adverse outcomes, notably mortality (Griffiths et al, 2018; Recio-Saucedo et al, 2018). What is the safest level of staff to care for patients? Safe staffing levels have been a long-standing mission of the Nursing and Midwifery Council (NMC)/Royal College of Nursing (RCN) in recent years. In the UK at present, nurse staffing levels are set locally by individual health providers. The Department of Health and professional organisations such as the RCN have recommended staffing levels for some care settings but there is currently no compliance regime or compulsion for providers to follow these when planning services (Royal College of Nursing 2019). I was surprised to find that there are no current guidelines on safe staffing within our healthcare system. It left me wondering… is patient safety a priority within our healthcare system? It seems not. While the debate and fight continues for safe staffing levels, healthcare staff continue to nurse patients without knowing what is and isn’t safe. Not only are the patients at risk and the quality of care given, but the registration of that nurse is also at risk. What impact does low staffing have on patients and families? ‘What matters to them’ does not get addressed. I shall never forget the time a relative asked me to get a fresh sheet for their elderly mother as there was a small spillage of soup on it. I said yes, but soon forgot. In the throes of medication and ward rounds, being called to the phone for various reasons, answering call buzzers, writing my documentation, making sure Doris doesn't climb out of bed again, escorting patients to and from the CT scanner, transferring patients to other wards – I forgot. My elderly patients’ daughter was annoyed, I remember she kept asking and I kept saying "in a minute", this made matters worse. She got annoyed, so that I ended up avoiding her altogether. How long does it take to give her the sheet? Five minutes tops, so why not get the sheet? MY priority was the tasks for the whole ward, tasks that are measured and audited on how well the ward performs by the Trust; filling out the observations correctly, adhering to the escalation policy, completing the 20 page safety booklet, completing the admission paperwork, ensuring everyone had their medication on time, making sure no one fell – changing a sheet with a small spot of soup on it was not on my priority list. It was a priority for my patients’ family. My patient was elderly, frail and probably wouldn’t get out of hospital alive this time. Her daughter was the only family she had left. It’s no wonder families feel that they are not listened to, are invisible, are getting in the way and not valued. These feelings do not encourage a healthy relationship between patients/families and healthcare workers. Studies have shown that involving patients and families in care is vital to ensure patient safety. Patients and their relatives have the greatest knowledge of patients and can often pick up subtle signs physiological deterioration before this is identified by staff or monitoring systems (O’dell et al, 2011). If our relationship is strained, how can we, as nurses, advocate for the safety of our patients? So, what impact does low staffing have on the staff member? "Fully staffed today!" The mood lifts at handover. People are sat up, smiling, quiet excitable chatter is heard. This uplifting sentence is quickly followed by either: "Let’s keep this quiet" or "someone will be moved" or "someone will have to move to XX ward as they are down three nurses". Morale is higher when wards are fully staffed. The mood is different. There are people to help with patient care, staff can take their breaks at reasonable times, staff may be able to get home on time and there is emotional support given by staff to other staff – a camaraderie. The feeling does not last long. Another department is ‘three nurses down’. Someone must move to cover the shortfall. No one wants to go When you get moved, you often get given the ‘heavy’ or ‘confused’ patients. Not only that, you are working with a different team with different dynamics – you are an outsider. This makes speaking up difficult, asking for help difficult, everything is difficult: the ward layout, where equipment is stored, where to find documentation, drugs are laid out differently in the cupboard, the clinical room layout is not the same. The risk of you getting something wrong has increased; this is a human factors nightmare, the perfect storm. I am in fear of losing my PIN (NMC registration) at times. At some point I am going to make a mistake. I can’t do the job I have been trained to do safely. The processes that have been designed to keep me and my patients safe are not robust. If anything, it is to protect the safety and reputation of the Trust, that’s what it feels like. Being fully staffed is a rarity. Being moved to a different department happens, on some wards more than others. Staff dread coming to work for threat of being moved into a different specialty. Just because you trained to work on a respiratory, doesn’t mean you can now work on a gynae ward. We are not robots you can move from one place to another. I can see that moving staff is the best option to ensure efficiency; but at what cost? Another problem in being chronically short staffed is that it becomes the norm. We have been ‘coping’ with three nurses down for so long, that ‘management’ look at our template. Is the template correct, we could save money here? If we had written guidance on safe staffing levels, we still have the problem of recruitment and retention of staff; there are not enough of us to go around. Thoughts please... Does this resonate with you? Has anyone felt that they feel ‘unsafe’ giving care? What power do we have as a group to address this issue of safe staffing levels? References 1. Wears RL, Hollnagel E, Braithwaite J, eds. The Resilience of Everyday Clinical Work. 2015. Farnham, UK: Ashgate. 2. Griffiths P et al. The association between nurse staffing and omissions in nursing care: a systematic review. Journal of Advanced Nursing 2018: 74 (7): 1474-1487. 3. Recio-Saucedo A et al. What impact does nursing care left undone have on patient outcomes? Review of the literature. Journal of Clinical Nursing 2018; 27(11-12): 2248-2259. 4. O’dell M et al. Call 4 Concern: patient and relative activated critical care outreach. British Journal of Nursing 2001; 19 (22): 1390-1395.
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