Accountability

On 31st March, a week or so after the coronavirus pandemic lockdown began, I was contacted by the HCPC.

I am writing to inform you that we have received a concern about your fitness to practise” the letter began. “We will now carry out an initial investigation into the potential fitness to practise issues identified in the concern. This may involve gathering relevant information from a number of sources.
  
In order to assist with our enquiries, I would be grateful if you would provide the following information:
  
– Confirmation that you are the owner and/or moderator of the site ClinPsy.org.uk.
– Confirmation of whether you, or any of the other owners/moderator of the site have received any concerns/complaints about the content of the forum, particularly regarding [celebrity psychologists]
– If yes, please provide a copy of the complaint/s and the site’ s response.
– If not provided above, you are welcome to provide a brief response to concerns raised.
– Confirmation of your current employment arrangement.
– If applicable, please provide the name and email address of your line manager and HR director.

I replied the same evening:

I own www.clinpsy.org.uk I can confirm that I have never had any complaints in any form about any comment on [celebrity psychologists] on the forum – in fact I have never even heard of [the complainant], and can find no reference to him on the forum. I’m afraid you will need to let me know what comment is being complained about to enable me to respond to it.
As to my employment, I am self employed and run my own small business, so there is no line manager or HR involved – but I have to ask why you would think that relevant when a person is complaining about an unspecified comment on social media?

I then contacted my professional indemnity insurance provider and spoke to Mike Wang, chair of the ACP (he was my MSc supervisor and then my clinical course director, and we have stayed loosely in touch since then) who were both reassuring that this wasn’t a legitimate complaint. Later I got legal advice through my membership of the FSB, to check I had fully understood my legal obligations as a forum owner. All of us wondered why the HCPC would launch an investigation at all, given that I had never made a comment myself about any of the individuals named in the complaint, and the forum had been very proactive in ensuring no defamatory content was permitted. The forum does have a thread about “celebrity psychologists”, where legitimate concerns are raised about individuals who appear on television or in the newspapers making comment as “psychologists” who are outside of the scope of HCPC registration. But I could see nothing defamatory in it. In fact the moderating team had carefully checked the content and I had even posted a reply to remind people about our defamation policy and how to raise a concern. So I started to draft a full reply to the HCPC.

Just to be sure, I spent many hours obsessionally trawling through content on the forum and my social media and could find no interaction with the individual concerned, or any defamatory content about any celebrity psychologist on my forum. That isn’t to say members of the forum haven’t criticised such individuals, or that I don’t share similar concerns. Quite the opposite, I’ve been raising concerns about the limited scope of regulation for psychologists and therapy professionals for more than a decade and see this as another example of where the legislation fails to protect the public. However, I have never expressed this as a personal attack on an individual, or said anything unprofessional or defamatory.

At this juncture it might be helpful for me to note what defamation is, what a complainant can do about online defamation, and what the legal rights are both of the individual who believes they have been defamed, and the established defences against claims of defamation, as they will set this complaint in context.

Defamation is the action of damaging the good reputation of a person through the oral or written communication of a false statement about them that unjustly harms their reputation. The important part of that definition is that the statement must be false, and it must cause them harm (which must be demonstrable within 12 months of publication). Being rude about someone or insulting towards them would not normally be defamatory, though it might be unprofessional. As a website owner I am technically the publisher of the content shown on the site, and whilst I cannot be held legally accountable for other users being rude or insulting (though we have worked hard to create a professional culture and to have policies that prevent personal attacks or unprofessional behaviour), I would be accountable if something defamatory was published – if I was aware of it and failed to act to remove it when requested to do so by the individual it affected.

The problem here was that the HCPC did not share any details of the complaint with me, and the complaint communicated was entirely vague and did not refer to particular comments or even allege defamation. It was also made by a third party, rather than the individual that the complainant said had been maligned – making it rather extraordinary that the HCPC would give it even a cursory investigation.

But even with the assumption that someone had said something on the forum that an individual had felt was defamatory – which was far from the case – the law requires that individual (not a third party) to inform the publisher and ask them to remove the content, within 12 months from publication. And in this case most of the comments about celebrity psychologists had stood for 7 years, and no complaint had ever been raised with the forum – despite every post having a button to report it to moderators for review, and a prominent defamation policy that was linked by me in the very thread concerned, in a post giving the forum email address to make such a report.

There are also two main complete defences to defamation allegations; truth and honest opinion. If a statement is true it cannot be defamatory. For example, to say that a celebrity psychologist is not a registered practitioner psychologist or does not have a doctorate is not defamatory if these statements are factually correct. The other defence is that someone is expressing an honest opinion or making “fair comment”. This allows discussion of matters of public or professional interest, and means it is not defamatory to express a view that an honest person could have held on the basis of any facts or anything asserted to be a fact by reasonable sources available to them at the time. That is, if I said “Boris Johnson is a liar” this could not be defamatory because numerous sources have asserted this to be the case. Honest opinion can also be a reaction to something else that has been published, and can even defend someone posting something that is incorrect, if it was an honest belief based on the information available at the time (for example, writing “X isn’t registered with the HCPC” wouldn’t be defamatory if a person had their HCPC registration in a different name, or it didn’t show on the website yet, or the name checked was spelt incorrectly because that was the spelling used in the article under discussion).

As far as I could see, all comments that were on the forum about celebrity psychologists, or made or retweeted by me on social media, involved telling the truth or making fair comment about known or published facts.

On the other hand, my investigations showed me that the complainant was someone who frequently threatens properly registered mental health professionals who criticise his favoured celebrity psychologists with referral to the HCPC. I also found that the individual concerned had used anonymous IDs to respond aggressively to critics of his favoured celebrity psychologists, and to place more flattering quotes and reviews about them into the public domain. I also heard from other colleagues who had been harassed for raising similar concerns. One noted:

This is one of the perversities about the register and use of the title psychologist; as [celebrity psychologists] are not registered they are able to freely mislead the public about their status and not be held accountable and yet they can put in complaints to the HCPC about those of us that are properly qualified.  The complaint is vindictively motivated [and yet effective as a deterrent/punishment for critics]

So on 2nd April I sent the HCPC a robust reply:

I have had a better look into this and I am now in a position to reply more fully.

For reference, the forum has run for 13 years and contains 152,000 posts on over 15,000 topics. We have never had a formal complaint about our content, and we have a team of moderators who are all HCPC registered clinical psychologists who help to ensure we maintain a professional tone in all content. Every user has to agree a statement about the rules of the site to sign up (which can be read here: https://www.clinpsy.org.uk/forum/viewtopic.php?f=2&t=16012) and we have written guidance for users that spells out our rules (which can be read here:https://www.clinpsy.org.uk/forum/viewtopic.php?f=2&t=10). The guidance is sent to each user in a welcome message as they sign in for the first time and cautions against personal abuse or defamation. Rules 9 and 11 specifically talk about being respectful of others even when disagreeing, avoiding defamation and ensuring posts do not risk bringing the profession into disrepute. It also explains how any post can be reported to moderators by clicking the small triangle button and stating your concerns. We have a pinned post giving specific guidance about defamation (see here: https://www.clinpsy.org.uk/forum/viewtopic.php?f=2&t=9&p=10) that is linked prominently from that guidance, and note it includes the means to contact us to report any content that is potentially defamatory at the bottom of the page: “If you believe a post has been defamatory about you, or an organisation you represent, please email us at clinpsyforum@gmail.com and we will respond as quickly as possible”. 

We have a proper process for responding to a complaint, and a team of qualified CPs who act as moderators that I consult with. However, our complaints process has only been activated once (when an approach to purchase the website turned into correspondence disputing our negative review of a travel agency offering work experience placements to psychology students, but they did not register a formal complaint and we did not find any content that was not factually supported when we investigated) and I can confirm that we have never had any complaint from any of the individuals mentioned in your email. We respond frequently to reports on individual posts, which mainly notify us of spam but can also highlight inappropriate content such as potential breaches of confidentiality. These are dealt with within 3 working days. We have never had a report in relation to defamation or to any content relevant to this complaint.

We do have one thread where [celebrity psychologists] are mentioned – you can read it here: https://www.clinpsy.org.uk/forum/viewtopic.php?f=12&t=13708. It was started in 2012 where forum members raised concerns about “celebrity psychologists” who do not have HCPC registration but appear to be giving the public the impression they are regulated professionals. The thread stood for 8 years and the majority of content was posted two or more years before I contributed to it at all. I did review the entire thread at that point and found nothing defamatory. Nonetheless my response includes the following: 

“The issue of psychological therapists who practise outside the scope of professional regulation is one that is important to many of our members who work hard to gain practitioner status with the HCPC, because we believe in the principle being important to protect the public (regardless of the individuals involved).

As with any other thread on the forum, if any of the content of this thread is considered defamatory the the individual involved is welcome to email the site (clinpsyforum@gmail.com) and point this out and we will remove it.” 

The thread was then dormant for nearly six years, before being raised to discuss the way some “celebrity psychologists” were using BPS membership to give the impression of professional qualifications, whilst apparently breaching BPS guidance. I had raised these concerns with the BPS and mentioned doing so on the forum and on twitter. However, as with the content in the thread, the concerns were about the misrepresentation of professional titles and skills, and the role the BPS take in giving credibility to psychologists who are not HCPC registered practitioner psychologists, and their lack of will to intervene or regulatory teeth when concerns are raised about these individuals. Whilst one or two of my posts are critical of specific things that [individual celebrity psychologists have] written or said I cannot see any defamatory content. I have made no direct criticism of [the individuals named in the complaint], and there has never been any mention of [the complainant] on that thread or elsewhere on the forum.

Nobody has raised a complaint about that thread. I have reviewed it today, and whilst there is legitimate concern about misrepresentation of qualifications and the public perception of psychologists, based on things written or said by various unregulated “psychologists” in the media, I cannot see anything defamatory in the content. [Far from being unprofessional, I believe we have gone above and beyond requirements to prevent defamatory or unprofessional content. I posted in that very thread] how to report any concerns about defamation, and have been mindful to allow only appropriate professional concerns about misrepresentation to be raised on the forum, rather than personal attacks or potentially defamatory content.

I do not believe that it can possibly impair my fitness to practice as a clinical psychologist to have hosted or participated in discussion about potential misrepresentation of professional qualifications by “celebrity psychologists”. This has not been defamatory, and I believe it to be legitimate for members of a clinical psychology forum to raise professional regulatory concerns about public figures – especially when these are factually based, shared by many practitioner psychologists and early career stage psychologists, and have been raised appropriately with professional bodies including the BACP and BPS. The posts on the forum that were critical of these individuals were based on the content of their newspaper columns and television appearances, how they are introduced in TV programs, and their stated qualifications and experience on their websites. For example, it is a true fact that Emma Kenny is not a clinical psychologist, despite being introduced in a BBC television series as being one, and this being a breach of the regulations that brought us under the auspices of the HCPC.

I would note that it is entirely lawful for individuals to publish honest opinions on a matter of public interest and based on facts which are true – this is known as “fair comment” or “honest opinion”, and has been tested through the courts by cases such as British Chiropractic Association vs Simon Singh, which led to the Defamation Act, 2013. This introduced a number of protections against allegations of defamation, including truth, honest opinion, public interest, and a defence for website operators hosting user-generated content, provided they comply with a procedure to enable the complainant to resolve disputes directly with the author of the material concerned or otherwise remove it. This ensures that individuals who own or run websites that allow comment are not liable for the content of other user’s comments on it. It requires that the complainant must contact the site owner or administrator to raise a complaint in which they specify the complainant’s name, the statement concerned, where on the website it was posted and explain why it is defamatory, before taking any other action in relation to alleged defamation. These complaints can only be made by the person who has allegedly been defamed or their legal representative.

We have never received any complaint or notification of potential defamation, or any communication from [celebrity psychologists] or their legal representatives, and as previously stated we have never mentioned, heard of or communicated with [the complainant]. Thus a non-specific complaint to the HCPC made by an individual who has never been mentioned on the site seems quite inappropriate as a means to address concerns. I would therefore hope that the complaint can be quickly dismissed.

Yet the case still wasn’t dismissed, despite the fact I had demonstrated that a) I had not made any defamatory comments about the individuals concerned and b) there was no legal basis to hold me accountable for posts made by others on a forum that I own (even had any been defamatory, when none of them had been).

I was then asked on 6th April to provide proof that no complaints had been made to the website. Aside from the fact that it is not my burden to prove a negative, and almost an impossible task, I spent the next 3 hours responding to this request, searching the email correspondence, administrator and moderator report logs for each name or the word complaint, and submitted screen shots of every search. These were acknowledged on the following day.

Yet the case still wasn’t dismissed.

I then heard nothing for 4 months. So I wrote on 12th August to ask whether the complaint had been dismissed. This email was acknowledged, and I was told I would receive a reply within 5 working days, but received no reply. I therefore emailed again on 20th August, which again had no reply. So on 26th August I raised a complaint.


My complaint was that this “fitness to practise concern” was obviously spurious from the start, and should never have reached the point of even a cursory investigation (given the complaint was from a person I had never interacted with, about comments made by people other than me about people other than him). But even if it did, in error, reach a cursory investigation, surely the information I provided within 3 days was enough to say “sorry, it is now clear this isn’t a legitimate complaint” and not keep me under the stress of a formal fitness to practise investigation? How this can still be hanging over my head five months later is very troubling. Surely there must be a process for checking the prima facie validity of complaints, that should have dismissed this? What if I had been employed, and this had led to me being suspended or fired? How you could do this to a person struggling to sustain their business through a pandemic lockdown over such a trivial and spurious complaint is beyond me.

On 4th September the investigation was officially closed. The HCPC informed me:


I am writing to let you let you know that we have now completed our initial investigation into the concerns we received about your fitness to practise.

During our investigation, we obtained information from the Complainant and yourself. We have now assessed the concern, and all the information we received, against our threshold criteria for fitness to practise investigations.

In doing so, we have considered whether this matter may be a breach of the following HCPC Standards of Conduct, Performance and Ethics:
2. Communicate appropriately and effectively
6. Manage risk

The outcome of our assessment is that the threshold criteria for fitness to practise investigations has not been met in this instance. This means that we do not consider that the concern, or the information we have obtained about it, amounts to an allegation that your fitness to practise may be impaired.

The reasons for our decision are explained in more detail below:

Issue 1 – comments of an offensive, bullying or inappropriate nature on social media

Registrants are not prohibited from expressing their opinions on social media, provided the content or language used is not inappropriate or offensive.

HCPC Guidance on Social Media advises Registrants: ‘ When using social media you should apply the same standards as you would when communicating in other ways. Be polite and respectful, and avoid using language that others might reasonably consider to be inappropriate or offensive. Use your professional judgement in deciding whether to post or share something.’

From the links and screenshots provided, the content of the forum appears to be confined to a discussion of professional concerns and information already in the public domain. Regarding the opinions and concerns expressed in the forum, the HCPC would be out of place to prohibit its Registrants from having a free discussion about their concerns or limit their ability to express their opinions. Of the information provided and the search conducted, I am unable to find any statements which amount to ‘trolling’  or bullying.

As our process is evidence based, we cannot proceed with our investigation without evidence to support the concerns. The Complainant was given multiple opportunities to provide evidence that you contributed to and offensive or inappropriate content, but has failed to provide information which supports the concerns.

Issue 2 – hosting comments by others of an offensive, bullying or inappropriate nature on your site

You have provided evidence that you have put multiple protections in place to ensure the tone, language and content of the forum is not defamatory and does not stray into inappropriate content or language. Where members breach these terms, you have a team of moderators who will respond.

In providing individuals the ability to report specific posts and comments, you have acted in accordance with your professional duty to support and encourage others to report concerns(SCPE 7.2). You have evidenced that you have not received complaints on this thread, and therefore have not been in a position to respond to such concerns.

In the absence of any evidence to suggest you have not complied with the relevant obligations, there is no information to suggest that your fitness to practise may be impaired.

We will therefore not be taking any further action in relation to this matter and have closed our file on this case. However, please continue to be aware of our communication guidance when reviewing your forum/website.

We appreciate that this has been a very stressful time for you and would like to thank you for your co-operation and patience during our investigation.


So, to my relief, they got there in the end and the complaint has been dismissed. However, my question is why the complaint got through the starting gates, and why it took 5 months, 2 emails and a formal complaint to resolve.

But more than this, why do the BPS continue to endorse these “celebrity psychologists” and do nothing to protect or support genuine practitioner psychologists against this kind of attack? Despite numerous complaints about “celebrity psychologist” Jo Hemmings in the context of her article about Meghan Markle being manipulative, the BPS sat her down for a chat and took her at her word that she would be more careful in future. And they’ve not replied to any of my emails in the six months since I suspended my membership, saying I would not continue membership until they responded to the concerns I raised about their endorsements not protecting the public.

And more than this, why does the legislation not distinguish genuinely qualified and accountable professional psychologists within the scope of regulation from anyone who calls themselves a psychologist? In Australia it is an offence with enormous financial penalties to misrepresent someone as a psychologist or claim to be a psychologist if not within the scope of statutory regulation. So the public cannot be misled by the media citing quacks or charlatans who claim qualifications, but actually have to check their registration before using them as experts. Here we haven’t even got that protection for who can be called as an expert witness to inform critical decisions in the courts. The scope of current regulation fails to protect the public, yet nobody – not professional bodies or politicians – seems to care.

Coping in a time of coronavirus

Are you finding it hard to adjust to the impact of Coronavirus policies on daily life? If so, you are not alone.

If you aren’t too saturated with top tips for wellbeing type posts, I thought I should share a little bit of basic advice compiled from my knowledge as a clinical psychologist and what I have read on science twitter, in case others are also struggling with the impact of social distancing and experiencing changes to their daily life that are causing high levels of anxiety.

Note: This blog is mainly targeted at those people who are staying at home and trying to comply with social distancing, rather than those of you who are doing the kind of essential work that has to continue to involve direct contact with others. If you are in that group, I’m incredibly grateful to you, but I don’t feel skilled enough to provide specific advice. If you have greater knowledge than me and would like to improve this blog (particularly in terms of the physical elements, which I appreciate will change as the situation and our knowledge base evolves) please let me know and I can fix things.

So, with that said, on with the blog.

It is a worrying time for many people, and there is a real threat that we have very little control over, but there are things that we can do, and you are not alone – we are all facing this together. So this is my very simple advice of where to start to ground yourself and remain as psychologically healthy as possible in these challenging times.

First the physical health stuff:

1) Do everything you can to remain safe and protect those around you. This means hand washing with soap for 20 seconds (make sure to wash between fingers, around thumbs and wrists and under fingernails if you have had any contact with someone who may be contagious), cough or sneeze into a tissue or your elbow rather than onto your hands, avoid touching your face, and follow the rules about social distancing. This means not greeting people with handshakes, hugs or kisses. Minimise your social interactions, and try to ensure you only interact with people outside your household bubble in a safe way – ideally outdoors or in a well-ventilated space. Unless you work in an essential role this means staying at home, not going to busy places or meeting up in groups, and trying to remain 6 feet away from others, especially anyone outside of your minimum necessary network. Wear a mask in any enclosed space apart from your home – try not to put it on and take it off more than you have to, and avoid touching the mask except by the strings.

2) Be aware that Covid-19 is potentially dangerous (particularly to people who are very elderly or have pre-existing medical conditions). It is worth avoiding as even if you are not in a vulnerable group you can pass it on to others, plus it makes some people feel like a very bad flu with aches and serious chest pain/breathing problems. However, for many/most people it may not be obvious that you are ill at all, let alone with a serious condition. If you have a dry cough or fever, or if you lose your sense of smell or taste, or if you feel suddenly exhausted/weak, you need to self-isolate to prevent spread of the virus.

3) Take extra care over social distancing if you have an existing health condition or are elderly, or if this applies to anyone else in your household. Ensure you have enough medication, and keep taking preventers if you are asthmatic. If you are in a high risk category, then where possible have deliveries dropped off without interpersonal contact, leave letters/boxes 24 hours before touching them and wipe plastic or metal surfaces with soapy water or sanitiser unless you can leave them for 3 days before opening. If you need to interact with others or use shared facilities, wash your hands and surfaces that others touch frequently (eg door handles, railings, keypads, taps, etc) with soap or sanitiser regularly and wash your hands after using them.

4) Remember that viral load may be important in how severely people experience the virus, and ensure that you take precautions when caring for a dependent with possible coronavirus, or if you think you have it, even if the symptoms are mild. A mask is particularly important in this situation. Anyone ill or who knows they have been exposed to someone who definitely had Covid-19 should stay separate from the rest of the family as much as possible. This needs to be for at least 7 days after exposure if you have had no symptoms, or after you stop having symptoms, but ideally 14 days or more. Where someone is ill but needs care use PPE/disposable gloves where possible, and keep washing your hands.

5) We need to both “flatten the curve” by slowing the spread of coronavirus so that we don’t exceed NHS resources (see above) and lower the baseline demand for NHS services. We can do this by avoiding preventable reasons for requiring hospital care. This means taking care of your physical health and existing health conditions (eg taking preventative medication/inhalers, following dietary advice for diabetes or high blood pressure), being mindful to reduce risk of accidents (eg drive slowly in built up areas, be extra cautious on trampolines or when climbing on ladders/chairs to reach things) and improving your respiratory and cardiovascular health (eg give up smoking, increase exercise, eat healthily, and attempt to lose weight if you are obese).

Politicians and NHS managers also need to act to grow the capacity of the right services (eg by postponing non-urgent treatments, discharging anyone able to manage at home, calling in staff who have recently retired or left the NHS, reprovisioning staff to where they are most needed and building field hospitals in case we need extra capacity). But each of us can play our part by reducing our risk of spreading the virus or adding to NHS demands in other ways.

But importantly you need to care for your psychological health too.

6) Connect with loved ones (physically if you are in the same household and nobody has symptoms, but virtually or with social distancing precautions otherwise) so that you do not feel alone. Hug your kids or your partner if you are together, or speak to them as frequently as possible if you are apart, and listen to how they are feeling. Keep in touch with your relatives and usual network via phone, social media, email or video chat. Make the effort to speak to your colleagues even if you are all working from home, keep in contact with your friends even if you can’t gather in person. Confide in the people that you trust.

7) Acknowledge that what we are going through is tough, even if you feel lucky not to be having to deal with it face on like those working in health and social care or doing supply chain or deliveries. Change is challenging, the perceived threat is intangible and unknown, so it is hard to reason with the anxiety it provokes, and uncertainty is stressful. The changes imposed on us to manage the outbreak take away some of our comforting routines and our expectations of the immediate future, and it is normal to worry about the impact on ourselves and loved ones. It is absolutely normal to feel shock, denial, anger, fear, grief, or a mixture of feelings and for these feelings to ebb and flow or change unpredictably (think about the Kubler-Ross stages of grief). You might find yourself literally shaking and/or crying, or you might feel nothing at all. Be kind to yourself, and give yourself time to adjust.

8) Manage your own anxiety. First and foremost, breathe (there are some good little graphics and apps about). Then make sure that you take care of yourself by doing all the basic things that we need; eat, sleep, exercise. Try to avoid increased use of alcohol or drugs, including smoking. Give yourself a routine. Confide your feelings in those you trust, or seek out support if you need it. Join in online mindfulness or therapy groups, or seek out personal therapy from a suitably qualified professional. If you have a garden or safe outside space, get out there and appreciate the elements. If you don’t, try to sit near a window and let some fresh air in when the weather isn’t too cold. Exercise and relaxation are both important. The former can burn off negative neurochemicals and produce more positive ones, and the latter can help you to soothe yourself (so indulge in a long bath, or listen to a relaxation video). Likewise sex (or masturbation) is good for our neurochemistry, can maintain intimacy in a relationship through a stressful period and/or help you to sleep.

9) Limit news consumption and stick to reliable sources. If you are feeling anxious you might want to learn everything about Covid-19, but whilst this can bring some temporary relief, too much focus on the potential threat can be counterproductive and increase your anxiety. So try to limit how much time you spend on news sites or social media, and ensure that you check the sources of what you do read as there are many seemingly plausible articles and posts that are not true doing the rounds. The BBC, World Health Organisation, official government sources or a trusted newspaper (for me that means the Guardian or the Independent) are probably more trustworthy than celebrities, social media influencers or some politicians. Don’t get your information about the outbreak from social media unless you have personal connections with medical/epidemiology experts and are very skilled at evaluating the quality of the sources and understanding the limitations to individual studies. You might wish to use your preferences on social media channels to tune out posts on coronavirus and covid, so that you can focus on more positive content.

10) Keep busy. Give yourself small goals and structure your time into small chunks, rewarding yourself for small achievements. Be mindful about what you are doing, and give it your full attention. Don’t let yourself ruminate, or slouch about in your pajamas all day. If possible, make sure that you sleep when it is dark and are awake for natural daylight. Stick to routines of mealtimes and maintain as many of your normal activities as possible. If you have less work to do, see this as an opportunity to do things you wouldn’t otherwise have time for. Try to find enjoyable activities or those that keep your mind occupied, whether that is arts/crafts, reading, gaming, sorting/tidying, decorating, programming, writing, making or listening to music, watching films/telly or learning something new (there are loads of fab free courses online).

11) Turn your focus towards the practical things you can do. For me that means trying to increase my cardiovascular fitness and lose some weight, because my pre-existing conditions mean I’m at greater risk, and my lack of fitness compounds this – so I’ve been trying to run up and down the stairs first and last thing each day, and each time I feel particularly anxious. This gives me a sense of doing something positive – and I can see that I am making progress. I started with sets of 2, but I can now run in sets of 3 and I am catching my breath faster afterwards than I was 10 days ago. You can choose an activity that suits your starting level of fitness, get out and walk or cycle or there are fantastic exercise videos of all sorts on youtube, so why not try some zumba or yoga or calisthenics. Or improve your living environment, or create or improve a garden or vegetable bed. These kinds of things will give you a tangible feeling of achievement and improve your quality of life.

12) Be kind to others. Manage your anxieties before you speak to children, answer any questions they might have and help them to feel safe and loved. Try to be kind and patient if children are off school, and don’t put too much pressure on to do academic work until they are in a calm enough emotional state to do so. Listen to loved ones and empathise with their experiences, even if they feel differently or are responding in a different way to you. Try not to buy more than you need, so that others can get some of key items too. Thank delivery workers, supermarket staff, carers and other essential workers, and don’t pass on frustrations about lack of stock or panic buying to them as they are doing their best. Reach out and make connections via notes, email, phone, social media, or video chat. If you are young and healthy try to be particularly considerate towards those who are not – keeping in touch with older relatives and friends or those with disabilities and/or health conditions whilst keeping them away from contagions. Join neighbourhood networks or the NHS volunteers list. Leave a note with contact details for vulnerable neighbours in case they need help with shopping or collecting prescriptions, or someone they can speak to on the phone or through the window if they feel isolated. Donate to food banks and local charities if you can afford to do so. Shop with smaller companies and local traders where possible.

13) Take time to be grateful for what we have. If you have people who love and care about you, appreciate them. If you have pets that share your life, pamper them. If you can access nature, take time to enjoy that. If you have had the opportunity of education and can continue to learn, value that. Remember that we live lives of relative plenty. Most of us have relatively secure places to live in locations with relatively good health services to fall back on if we need them. Many of us have meaningful work to be involved in, and live in developed nations with some form of social security to fall back on and/or within networks that would support us in a crisis. So although there are greater challenges in our daily lives, we still have a lot to feel grateful for. Focusing on the positives helps you put the challenges into perspective.

14) Know that we’ll solve this in time. So many brilliant people are working together to address this new disease. Health care professionals are doing brilliant work all around the world. Scientists are hard at work exploring faster and more effective tests and treatments. Potential immunisations are being tested. Antigen tests will soon show who is contagious. Antibody tests are being developed that will show who has already had and defeated Covid-19 and can no longer be a vector for transmission. These people can then step up to key roles caring for the most vulnerable, and their antibodies can be used to treat the most sick. UVC has been shown to kill the virus, and robots are being built to sanitise rooms and equipment to increase hygiene. Advances are being made all the time.

15) We all know the bad things that are happening or likely to happen, but some good things will come out of this too. Pollution has been reduced by the decreased travel and factory activity, saving lives of vulnerable people, especially in the developing world, as well as helping the environment. Reduced car journeys might mean reductions in accidents. Political recognition of changing public perceptions should lead to greater investment in health and social care, as well as increased funding for medical research and response-readiness for the future. The pandemic has also shown that all nations face the same threats, and all people are the same, so (with the exception of some racist idiots) it has increased international cooperation and the knowledge that we are all interconnected. This has the potential to allow greater collaboration on international issues in future, and this may help resolve conflicts and address environmental issues. Mass working from home has shown that it is possible for more people to work remotely, meaning there are likely to be reductions in travel and more adjustments for people who need it available in the future. It has also highlighted the value of essential workers in supply chains and delivery as well as in health and social care, raising their status and priority in public perception. The economic impacts have shown the value of universal health coverage, social safety nets, and minimum income guarantees. It has reduced the mindless consumerism of recent years, and made us conserve resources and reduce food waste. So hopefully we will come out the other side having learnt some important lessons.

Pessimism, propaganda and politics

I can’t be on the only one being crushed into learned helplessness and pessimism by the triumphalism of the far right taking over British politics, and the impending Festival of Brexit. Unlike the Brexit referendum result, the election of Trump and the results of past elections in the UK, this time I knew it was coming. But that hasn’t made it easier to accept. So how did we get here? And what should we do now? I figured I’d split some content out from a diversion on a previous blog and then share some thoughts about the leadership of the labour party.

It seems evident we are now in a time of propaganda and fear-mongering, where the truth has been lost amongst distortions and misinformation. Adam Curtis captured this prophetically in Charlie Brooker’s 2014 end of the year show (shown in two tweets from the marvellous Carole Cadwalladr here). Misinformation and bias is now pervasive in the way we receive our news, which is mostly delivered via social media and decided by algorithms based on past viewing choices in a way that reinforces our narrow bubbles. The news we read is skewed by the need to to keep us coming back to see the advertising content that funds it. And that means it is full of carefully curated fear, uncertainty and doubt, in between the filler of social media anecdotes and celebrity gossip. No wonder it feels like there are so many layers of bad news in the world at the moment.

Even when we take the time to read a newspaper cover to cover, we hear about so many hideous individual crimes not just in our locality but nationally and internationally because the world is so connected now – the latter often only identifying their location way down the article, meaning the headlines make us feel these are all risks that affect us personally. It makes it feel like the world is getting more dangerous even though the reverse is actually the case. There seem to be so many horrendous incidents of stabbings and shootings, and the ongoing human cost of the various war/conflicts going on in the world. And we start to feel as powerless as we do about the terrible weather events of different types that are being reported all around the world, from forest fires to floods and loss of ice fields. You’d think we know enough already to stop the global warming that is fueling the volatile weather, address the causes of conflicts and mediate solutions, and have effective police and criminal justice systems around the world. But no. It seems as developed nations, we prefer to make superficial changes to actually implementing real change when it comes to the environment.

Sadly, that is no surprise given the disproportionate influence multinational corporations have over policy. We seem to have increasingly allowed the super-rich and corporations to covertly buy influence through donations and lobbying. This lets them promote the kind of politicians who will increase the wealth gap further still, remove consumer protections and “red tape” and allow creeping privatisation of public services. The same forces let the far right foment prejudice and anger through internet and tabloid propaganda, so the focus of blame is always downwards toward vulnerable groups and not upwards to those with wealth and power. To compound and consolidate this, in the UK we have chosen to immobilise our entire system of government, civil service and public and private sector management for three years whilst deciding how many feet to shoot ourselves in under the banner of Brexit. This has never been more obvious than in the last week, where we are now poised to undermine all the checks and balances, and scupper the next few years of economic growth to entrench this new post-truth hard right populist culture for future generations.

And whilst the Labour party try to elect a new leader with the credibility and passion to challenge this, the left is fragmenting rather than regrouping. I’ve seen so many posts about Corbyn and Corbynism, trying to make out that idealogical purism is still the way forward, that we lost the election but won the argument and should do more of the same. Another Angry Voice posted as if it was irrational fear of renationalising transport and utilities that was the problem, concluding “If you’re afraid of Jeremy Corbyn’s economic policies, I’m afraid you’re pretty much the dictionary definition of a narrow-minded little Englander aren’t you?” I couldn’t disagree more. Frankly, I doubt many progressives disliked Corbyn’s policies, especially individually. However, together his policies will have seemed very disruptive and expensive not just to conservatives but to a lot of the middle ground and left-of-centre voters that are so vital in gaining a majority in UK politics – meaning he didn’t have mass appeal. Yet he was undoubtedly a good guy – warm, kind, genuine and thoughtful, and held in high regard by everyone who knows him personally. So was this also an example of a tendency to make snap judgements by first impressions, another consequence of unhelpful stereotypes of what a good leader is like, proof of a corrupt media or some combination of all of these things? I’m not sure.

Even to the diehard lefties (and I’d consider myself left of Blair, and someone who had great hopes for Corbyn in the beginning) Corbyn wasn’t the right fit for the job of heading up the opposition or being elected prime minister. Many of us worried about his leadership ability, his ability to be decisive and persuasive, to convey ideas in simple soundbites, and his failure to crack down on antisemitism within the party – giving the biased millionaire-owned media a stick to beat him with. But most of all, we worried about his choice not to articulate that Brexit was a tax evasion ploy by the super-rich that would harm the most vulnerable most, but also cause child poverty, cuts in public services, the break-up of the union, weaker negotiating positions that allow US pharmaceutical companies to charge more to the NHS and infringement of our right and liberties. Instead he believed/pretended that labour could offer a “good Brexit” of some kind, and lost half his supporters. He then failed to form any kind of progressive alliance, and instead allowed attacks on progressive peers in other parties, which was the nail in the coffin for the election.

So where do we go from here? Is it just about getting a new leader who gives a better first impression? It seems to me that politics has polarised the historic broad and diverse parties on either side of the house into narrow camps at either extreme of the political spectrum, leaving a lot of us disenfranchised by the first past the post voting system and the recurrent gerrymandering of constituency boundaries. We can see it in the hard-right Brexiteers that now dominate the Conservative party, but we can also see it in the way that a dominant and vocal minority supporting Corbyn and accepting no deviation towards incorporating a broader range of voices or considering what policies might be popular or electable has taken over the Labour party. Perpetuating this narrow view of purist socialism in which everyone else is “narrow minded” or a “red tory” is a very significant part of the problem – to win elections you need mass appeal, not to attack and alienate anyone even one degree outside of your bubble. I think Tim Minchin is right that its a massive problem with social media culture that the Overton window for each tribe is now tiny and any deviation leads to people being shamed and out-grouped (“I am afraid to write anything that might upset my own tribe”).

As this twitter thread articulates, I’d much rather have a centre-left prime minister doing many cumulative good things that are slightly less rapid or radical, than for all my beliefs to remain represented by an increasingly narrow, segmented and ineffective opposition. An amazing amount can be done within a party and set of policies that have broad appeal. For all his flaws, the centre-left Blair government made a huge amount of impact in numerous areas:

They lifted 600,000 children and 1 million pensioners out of poverty, provided winter fuel payments, free bus travel for over 60s, free TV licenses for over 75s, and improved a million social homes. It doubled school funding for every pupil, added 36,000 extra teachers and 274,000 teaching assistants, transforming education, leading to record literacy and numeracy. They opened 2,200 Sure Start centres and provided free nursery places, giving a better future for millions. They raised child benefit by 26%, introduced child tax credit and 3 million child trust funds. They invested in the NHS, employing 85,000 more nurses, cutting NHS waiting times by 82% and got in-patient waiting lists down half a million. Heart disease deaths fell by 150,000 and cancer deaths by 50,000. They implemented the smoking ban that has contributed to a 30% decline in the number of smokers in the UK, with massive impact on numerous health morbidity statistics. They created NHS Direct. They also improved employment rates and conditions: they introduced minimum wage, created 1.8 million new jobs, cut long term unemployment by 75%, doubled the number of apprenticeships, and introduced right to 24 days holiday and 2 weeks paternity leave. They employed 14,000 extra police, cut crime by 35% and increased criminal justice (court) spending by 21%. They negotiated peace in Northern Ireland, brought in the Human Rights Act, doubled overseas aid, wrote off debts for the poorest nations and created GiftAid. They Scrapped Section 28 and introduced Civil Partnerships. They banned fox hunting, and gave free entry to museums and art galleries. They also managed to couple this with the longest period of low inflation growth since 1960, and created less debt than the governments before or since them, despite bailing out the banks. I’d say that’s pretty remarkable, and something to aim for achieving again.

However, at the last election, perhaps because of Brexit and this ideological purism – we (on the progressive left) didn’t manage to instill hope for positive change in the people of Great Britain, or to challenge the vacuous headline of “get Brexit done”. The election results were depressing but felt somewhat inevitable. As frustrating as it is that we have a government the majority of the population didn’t vote for, giving us a hard brexit that the majority of people don’t want, whilst we watch the world polarise and allow neo-fascist populists to rise, there are some tiny silver linings: The Tories have to work out how to do Brexit and will be responsible for the consequences and, hopefully, the Brexit party are gone.

I think this time around we need to pick someone who stands for all the right values, but has been able to articulate them in a way that has made real traction and can engage a much wider range of people. As much as I’d like that to be a woman, ideally from the north of England, supported by someone with a differing ethnic or cultural background, from the line-up on offer, I think Keir Starmer is the right person for the job. He’s spent his whole career knowing, following and effectively challenging the rules and processes of the legal system for the benefit of ordinary people, including challenging corporations and government policies and holding them to account. And he has done so without seeking personal glory, or making a reputation as a troublemaker. Whilst I really like Jess Phillips, I think she is too marmite to gain mass support and bring the country back together. Emily Thornberry seems nice, but very much a part of the north London bubble, and I don’t think the other candidates have the public profile or despatch box clout of Starmer,and we will at least get Angela Rayner as deputy leader.

Picking yet another white man from London for a political leadership role feels frustrating, as it plays into all the stereotypes of what a leader looks like. But I’m prepared to make compromise to get greater influence for progressive policies that will make the biggest impact on diversity in the long term. Plus we can only choose the most credible candidate standing. And for me that’s Keir Starmer. Hopefully he can bring the party together, tackle the scourge of antisemitism, and speak out in a way that appeals to a much wider demographic and geographic population than his predecessor.

I sincerely believe that if we all work together to encourage compromise and collaboration hopefully a more effective opposition can rise from the ashes that is more willing to be welcoming to a broad range of voters and more able to articulate how the current government continues to benefit the richest few at the cost of the rest of us, and particularly the most vulnerable in society. We need to show that the choices that Johnson and his remarkably homogeneous new pack of white male cronies are making are directly responsible for harming the welfare of large numbers of Brits. Current Conservative MPs being only 24% women and 6% BME is pathetic, and the greater diversity of candidates on the left should bring us a plurality of ideas and allow us to appeal to a wider demographic and opinion range amongst voters, if we get out of the silo mentality.

But more than that, we need to take on the issues. We need to campaign for environmental action nationally and internationally, strengthening of the legal system, an end to racism, xenophobia, antisemitism, islamophobia and discrimination, and the important task of electoral reform, so that we don’t end up with scumbags in power or people who lose elections being given cabinet roles via the House of Lords. And we need to grasp the nettle with proper regulation of social media as a publisher. But they will only take action if enough of us insist on it. As I said earlier, the million dollar question is whether we want things to change enough to take action, and to find common ground. I’ll end with the wise words of Jo Cox, “we are far more united and have far more in common than that which divides us”. So let’s act like it!

16/2/2020: Lisa Nandy just made a really good speech about anti semitism that has really raised my opinion of her, so maybe there is a woman from the north that can do the job after all!

Grand ideas

I recently filled in an application to speak at an event about children in Care. The form asked me to summarise in a limited number of characters what I would bring to the table as a speaker. I wrote:

We have collected BERRI data on the psychological needs of over a thousand children in residential children’s homes over the last five years, and surveyed and trained over a thousand residential care staff to provide care that is tailored to those needs. We can present what this data shows us, and how we have used it to improve the services that are offered, and commissioning decisions made about children. For example, we have learnt that the level of challenge presented varies remarkably little by age or gender, though the types of needs are slightly different. Some types of needs (eg behaviour, risk) are affected much more by proximal stressors (eg exclusions from school, gang involvement, substance misuse, sexual exploitation) whilst others (eg relationships) are affected more by historic adversity and the nature of early attachment experiences. We can present how staff variables (demographic factors, burnout, empathy, ability to formulate) affect the care they deliver, and how the price and types of services commissioned relate to the needs of the child and the impact they make on the life of the child – if at all!

The government spend a billion pounds a year on these 7000 children, and we have good evidence that by better targeting the psychological needs of individual children they can improve outcomes whilst saving costs.

It struck me when I looked at that paragraph that this was simultaneously a grandiose claim and underselling the potential of the systems we have developed*. I think that tension between over and under-selling what we can do reflects one of the big challenges of being an entrepreneur – seeing the potential, whilst being realistic about the frustratingly slow steps it takes to achieve it. I can see so much that we can achieve, and the way that collecting the right data can help put children’s needs in the heart of commissioning decisions, improving outcomes whilst saving substantial amounts of money but it is very hard to get this information in front of the right people. I’ve tried to speak to politicians, policy makers, experts in the field, commissioners, clinicians, funders and the media. I’ve spoken at conferences, written a book, contributed to policy documents, delivered service improvement programmes in major providers in the sector, I’ve even given evidence before a select committee. But because I try to answer the questions that are asked, I don’t always get the chance to promote the products and services that we provide. And it isn’t my personality to aggressively sell what we do.

Looking back, I think that I believed that if you work out a better way to do something, a technique that saves time or money or improves outcomes for people, then once people knew about it then it would start to gain traction until it became the established way of doing things. I figured that was how we had progressed from horse-drawn carts to steam engines, cars and now electric vehicles, or from papyrus to paper to typewriters to computers to the plethora of voice-activated, photo-capturing, text and graphic app laden smartphones – finding iteratively better ways to solve problems. I knew that sometimes there were two simultaneous steps forward that competed (like VHS and Betamax) and that variables like marketing, networks and budget could influence the choice, but I generally thought that the best solutions would win through. Maybe it is my left-leaning political bias or my hippy upbringing, but I think in my heart I have held onto a naive idea of fairness in which everyone should be motivated to solve social problems, and people should be rewarded for their effort and insight.

I suppose the concept that we live in something of a meritocracy is quite a widespread belief, and entrenched in western cultures, that good ideas will surface and the best people will rise to positions of power. That’s taken a bit of a crushing for me over recent years, as I’ve seen the covert influence of the super-rich and we’ve had several prominent examples of terrible people rising to the top of systems that have failed to keep up with social and technological change, but somehow I am still hoping for the system to right itself, because it feels like society should be a functional meritocracy.

I think it is particularly well articulated in the USA, because they started as a nation of immigrants who created their own society. To quote the American Declaration of Independence, “all men are created equal”, are entitled to “the pursuit of happiness” and will rise to their natural position in society. That sounds like a fair way to run a country, but of course the reality has never quite matched the headlines, given the theft of land and resources from native peoples, the decimation of the natural environment and the evils of the slave trade. But somehow the myth of the American Dream has persisted. First described by James Truslow Adams in 1931, it describes a culture where anyone, regardless of where they were born or what class they were born into, can attain their own version of success in a society where upward mobility is possible for everyone. The American Dream is achieved through sacrifice, risk-taking, and hard work, rather than by chance or the privilege of your pre-existing connections. In Adams’ words it is:

a dream of social order in which each man and each woman shall be able to attain to the fullest stature of which they are innately capable, and be recognized by others for what they are, regardless of the fortuitous circumstances of birth or position

Whilst I can see so many places where people are not starting the race from the same starting line, because of geography, race, gender, religion, socio-economic adversity, sexuality, age, or so many other variables I have clung on to my optimism that if you can work out a solution to a big social problem, or have an idea that can really work to make life easier (and/or make lots of money), then it should be possible to gain traction with it, get key people to support you, and get it to happen. The reality is that so many people who think of themselves as examples of a working meritocracy have in fact been handed a huge head start by their privilege. As we joked the other day on Twitter, all the wrong people have imposter syndrome because it is mutually exclusive with entitlement. It seems that private schools in particular train people to expect to be leaders and wielders of power, as we see in the preponderance of Prime Ministers educated in Eton (and in the irritating arrogance of Lottie Lion and Ryan-Mark in the recent series of the Apprentice). Having attended an ordinary comprehensive, and never having been aware of any negative repercussions of my gender or heritage, it has been quite eye-opening to see that maybe the playing field isn’t as level as it appears, even for someone ostensibly white and middle class**.

One figure that has stayed with me is that of all the money invested into fledgling businesses in the UK, 89% is given to all male founder groups, 10% to founder groups containing men and women, and just 1% to all female founders. I couldn’t find any UK numbers, but the figures look even worse if we consider race, with black women only receiving 0.0006% of the of the $424.7 billion that has been invested into startups globally between 2009 and 2017 by venture capitalists. Those white men probably think they simply have better ideas, but the evidence doesn’t support that, whilst the statistics say they are 89 times more likely to be funded than all female groups, whilst a white male entrepreneur is thousands of times more likely to be funded than a black woman, and will have the confidence to ask for much larger sums of money. Only 34 black women have raised more than a million dollars of investment in the last decade. This doesn’t reflect the quality of the idea or the work ethic of the individuals involved (as meaningfully empowered women on boards increase corporate social responsibility and may have a positive impact on the profitability of the business, and diversity increases profitability). It reflects the stereotype of what the (predominantly white male) funders think successful entrepreneurs look like – and they imagine young geeks from silicon valley who are predominantly white and almost always male. And that sucks.

It might also explain why men in suits with glossy patter are able to sell systems they have pulled out of the air for eight times what we charge for properly evidenced tools that do the same job better. Or maybe that’s just a coincidence. But whether or not the playing field is flat isn’t something I can solve alone, and it is unlikely to be resolved within the timescale that is critical for me to make a success of my business and to maximise the impact I can make on the lives of vulnerable children. That means that, despite how discouraging it is to realise that we are not living in a meritocracy where the strength of the idea is enough to sell it to those who matter, I need to find ways to shout louder, communicate what we do better, and get our message in front of the right people.

Because we are tantalisingly close to having all the data we need to understand the critical variables at play in the psychological wellbeing of children and young people in Care, and which placements and services can help to address them. We have an exciting partnership growing with a group of local authority commissioners that will couple our data with commissioning data, and we are applying for grants to help us to gather and analyse that data across much wider samples. We are also scaling up the previous project we did looking at whether BERRI can help to identify suitable candidates to “step down” from high tariff residential settings into family placements with individualised packages of support. These larger scale projects mean that we will be able to show that the model works, at both the human and financial levels. And with a little bit more momentum we can start making the difference I know we are capable of. The trick is hanging onto the vision of what is possible and celebrating what we have already achieved, whilst having the realism to put in the graft that will get us there. I need to keep pushing upwards for longer than I ever imagined, in the hope of reaching the fabled sunlight of easier progress – even if so many variables skew us away from the meritocracy that I imagined.

 

*I think that’s why I used the pronoun “we” and shared credit with my team, even when I was asked to describe myself as a speaker, rather than taking full credit on my own. This transpires to be a common female trait, and part of the double bind for women where being assertive is seen as aggressive whilst being collaborative is seen as lacking leadership. In fact, many words are used exclusively towards women and highlight how pervasive these biases about women in leadership roles are.

**albeit a second generation immigrant to the UK, with Jewish heritage

The rise of the bad guy

Trigger warning: first two paragraphs mention paedophiles, middle section is about racism and sexism, later content is political

The first time I met a paedophile I had no idea. He didn’t wear white towelling socks that showed below his slightly-too-short trousers, he didn’t wear a dirty trench coat, and he wasn’t a socially awkward man with greasy hair, unflattering glasses and a slight squint. Quite the contrary. He was a well-groomed, educated, articulate, middle-class man. He attended appointments to express concern about his grandchildren, and appeared supportive to his children in trying to sort out their problems. He was polite to professionals, and always thanked us for our time and expertise. I later found out that he had sexually and physically abused several members of the family. Looking back, our only clue (beyond the fact the children referred to us were evidently troubled and failing to thrive) was that the receptionist in one clinic said that she didn’t like the way he spoke to his wife in the waiting room, saying “I wouldn’t talk to a dog that way”. But we didn’t know how you could appropriately record that in the notes, given only the children were open to the service. So we didn’t record it.

The next time I met a paedophile he didn’t fit my stereotype of a creep or bad guy either. In fact, he tried to be my friend and find areas of common ground. If I hadn’t met him in my professional capacity and known of his conviction in advance, but instead had met him socially under different circumstances, I suspect we would have found some. Perhaps we would have had a pleasant conversation about politics, video games or running internet forums, and I’d have left thinking he seemed like a nice person. He was young, outgoing and wore a colourful T-shirt referencing a slightly crude meme. He was charismatic, informal and irreverent, and he flirted with the admin staff. However, I might have picked up on something when I found out his partner’s IQ was more than 60 points lower than his, that she had a serious trauma history, and they had met on a dating app for single parents where his profile bragged of how much he loved children. But I doubt his attraction to vulnerable single mothers is something apparent to most people that meet him, at least until they know him well.

The opposite face of this coin, where people assume they can judge a person’s character accurately from superficial appearances, almost certainly contributes to a lot of prejudice and discrimination. So many people from specific population groups are assumed to be aggressive, untrustworthy, or unacceptably different because of their culture or religion – but whether people experience these prejudices or not doesn’t reflect their behaviour or beliefs (or even whether they actually belong to the assumed demographic). Think of the prejudice about gypsies and travellers, or Muslims, or young black men, for example. Likewise the stereotypes about gender, or age. As I mentioned in another blog post, women in the public eye get judged for how well they conform to societal expectations of women – to look decorative at all times, to not be perceived as “aggressive” and to look after others. Any emotional expression is seen as a weakness compared to the perceived standard of cold logic that is perceived as more masculine and therefore preferable. There is a whole lexicon of words used to put women down when they step up to the plate.

Again, most of us are blind to our prejudices and we are also blind to our privilege. We assume an equal playing field when we congratulate ourselves for our achievements, and we don’t see the constant attrition that marks facing prejudice that contextualises individual incidents. This forum conversation (from post by mr0860 near the bottom of page 2 onwards), this twitter thread and this twitter thread show exactly what happens when the recipient flags sexism or racism, but those in the audience who have not experienced it do not pick up the same cues. You end up with a split between those who think it is legitimate behaviour/debate and those who are fed up with it (the recipients of the behaviour). The former group are disproportionately white men who have never been on the receiving end of the issue they cast doubt on. In fact they often haven’t even witnessed the issue first hand, giving them the false impression that it is rare, due to the false belief we all hold to some extent that our own experience is universal. The latter group are then branded as over-sensitive snowflakes stifling debate (though ironically it is those bandying those terms about who cry the loudest if they feel they are being criticised or their voice isn’t being given enough credit, see Stephen Yaxley Lennon or Milo Yiannopoulos).

Meghan Markle has been a particular victim of this pattern, as a mixed race woman that has used her platform to speak up for feminism and against racism and inequality, so it is no surprise that the vested interests of the British tabloid press dislike her and want to put her in her place. Yet there are still those who claim it isn’t racism, or that she brought the problems on herself in some way. In this brilliant clip Dr Shola Mos-Shogbamimu calls it out perfectly. The emotional labour of explaining or performing inequality is exhausting, and falls disproportionately on those who are subject to the prejudice in the first place, who already have additional burdens to carry.

My point is that we all make assumptions about other people, and often we aren’t as good as we think we are at picking out people’s true character from their appearance or what we get to see of them before we know them well. In fact sometimes we can know people very well and still miss huge facets of them, as is often evident in the terrible guilt and grief post-mortem when someone dies by suicide. The same thing might also contribute to why people enter relationships with partners who later become abusive toward them. Yet we are often blind to what we don’t know – I had someone on twitter recently claim to be certain that nobody in her extended network of over 100 friends and family members has ever experienced mental health problems. Statistically that’s as probable as a lottery win on a day you get struck by lightning, unless her family deviates very far from the rest of the world population in some way.

That isn’t to say there aren’t horrible people who are outwardly and obviously bad. There are. And I’ve met plenty of them, both personally and professionally. But I don’t think we can always pick them out from a line-up. And even when we can, it doesn’t seem to always hold them back. After all, we’ve had some very popular and powerful men come to light after many years of sexually abusing people on a massive scale (eg Weinstein, Epstein, Savile). There are also more than a few repugnant men in prominent political positions at the moment. Somehow being a division-stoking, lying, philanderer who will take whatever political position is expedient to him or his far-right paymasters, or a hate-mongering, tax-dodging, cheating, sex-pest who has asked foreign powers to interfere in his country’s elections hasn’t blocked two rich, overweight, blond men from some of the most powerful offices of power in the world. Far from it. Instead of their moral character being a barrier to office it is a selling point. Rather than denying or attempting to mask their true nature, they have started to double down in the knowledge that it isn’t reducing their popularity. Perhaps their carefully constructed persona of being harmlessly dim keeps them filed under ‘amusing oaf’ rather than ‘dangerous autocrat’. It is clear that their simplistic slogans have appealed to populations fed up of being ignored or talked down to, and made them seem more down to earth, whilst their decisions (no matter how hypocritical or founded on lies) make them seem like men of action.

I can’t be the only person that finds this incredibly frustrating. Surely we need to value truth and honour and block bad people from power? We need to stop it being amusing or acceptable to lie, express prejudice, exploit others, or to foment hatred of vulnerable people, and that means challenging the way that this is reported. Critical in this is the regulation of social media, and the support of journalism that is ethical and independent, rather than being reliant on social media, misleading narratives from biased sources and badly checked hearsay that spreads more rapidly and widely than the corrections that follow. I’m with Carole Cadwalladr that this is key to helping the public understand the truth about key issues and allowing democracy to function. If everyone who wanted progressive values to stand a chance in the world boycotted Facebook and lobbied for better regulation, their advertising revenue would fall and their business model would have to change. The million dollar question is whether we want things to change enough to take action, even if this means we have to find alternate ways to journal and share our lives with our networks*. Otherwise the bad people might tighten their hold on power and lead us in increasingly worrying directions.

 

*If that feels too much of a step, then I’d recommend you take three simple areas:
  1. Increase your privacy. On Facebook change your name and set your privacy settings higher so little or no information is public. Be wary of services with poor privacy and data protection.
  2. Be more data savvy. Watch The Big Hack. Be aware of what data you are giving way. Be mindful of what data your mobile phone and/or internet browser is collecting and what “personalisation” of advertising you are allowing, read what you are consenting to in the user agreement for apps and software
  3. Install apps that block advertising and show who is funding the adverts you do see. I use FB Purity and Who Targets Me?

Heart and Head

It is an interesting fact that most people make decisions based on their emotional “gut feeling” but then justify them logically in retrospect. So you pick a house or a car that feels right, but tell people you chose it because of the miles per gallon or the lovely neighbourhood. Maya Angelou put it rather perfectly when she said

I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.

However, if you ask me why I think BERRI can benefit a placement provider or a local authority, then my first port of call is facts and explanation, rather than finding the emotional hook that will persuade people that it feels like the right thing to do. Maybe its the scientist-practitioner thing showing through, but I feel like it is more valid or legitimate to make the case in the language of logic and facts, than to try to pull on people’s heart strings, and I am very loathe to make any claims I can’t prove with quantitative evidence.

I think that is partly because of my personal style. I have previously blogged about how I am not a typical clinical psychologist in terms of not seeing myself as primarily a therapist. I wonder whether that is because I tend to start with a more intellectual approach, and address the language of emotions less than many people in my profession. For example, I like to operationalise how I conduct assessments, or the information I like to share in consultations, so that it can be replicated more easily, and to evaluate everything I deliver to check that it is effective. It doesn’t mean I’m not mindful of feelings that arise for people I interact with, or in myself, or that I’m emotionally closed off. In fact, quite the opposite, as I quite often find myself becoming tearful when discussing the stories of the children and families that I’ve worked with (or when reading the news or discussing the current political situation, and even when watching films or reading novels for that matter). I’m likewise prone to a giggle or a belly laugh, sometimes about entirely inappropriate things. I’d say I’m pretty comfortable expressing both positive and negative feelings, and responding to those in others. But when communicating information to others, particularly in writing or as a presentation, science is my starting point.

Maybe it comes from eight years of academic study and writing before I qualified as a clinical psychologist, or maybe it is because I am used to presenting to my professional peers through journal articles and conference presentations. But ask me to explain about a topic or project and my first instinct is to tell a summary of the context and then share my methods, results and conclusions. However, I am mindful that to be an effective salesperson I need to be able to pick out the message that will be emotionally resonant with the listener to focus on, and to capture hearts as well as heads.

To that end, I’ve been working on how we communicate the impact of BERRI on individual children, as well as its benefits for organisations and commissioners. To do this we have started to capture some stories from cases where BERRI has made a difference, and then to anonymise these enough to present them in the materials that I present at conferences and on social media. I had always thought that the lovely animation that Midlands Psychology commissioned to show how they had changed the autism service was a brilliant example of this. I felt like they managed to tell the important elements of their story in an engaging way, and that this couldn’t help but make people see the improvements they had achieved. We didn’t have their budget, but I wanted to capture something similar in our case study animations.

Luckily for me, I had recently reconnected with an old school friend, Joe Jones, who is brilliant at this kind of thing. His “explanimations” for the renewable energy sector had been great at simplifying complex ideas, and he knew all about my business, as he had been helping us to look at our comms. We talked about what I wanted from an animation, the tone we wanted to convey, and the stories that we could tell about different case examples. Joe showed me how The Girl Effect had been able to capture an emotionally compelling story in very simple graphics, where the character created represented every girl, because she was effectively anonymous and culture free.

The result is a short animation that I think captures what we are trying to achieve with BERRI. Obviously, there is more information that will set the simple story into context, which I can tell people in the rest of my presentation, or as they enquire. But as a hook that helps people to see the impact it can make, I think he has done a great job.

BERRI Case Study – Daniel from Joe Jones, Archipelago.co.uk on Vimeo.

What do you think? Does it explain what we are offering? Does it appeal to both heart and head?

Can you make things better for children and young people in Care whilst saving money?

That seems to be the critical question in an age in which there is no money in the budget to try anything innovative just because it will create improvement. To be able to try anything new that involves spending any money we have to evidence that double win of also saving costs. A few years ago when I was in the NHS, I found that really frustrating – I had so many ideas about how we could do things better by creating new services or better collaborations with other agencies, or reaching out to do the proactive and preventative work that would save money down the line, but it was almost impossible to get them off the ground because the budgets were so tight. Since then I’ve tried various things to unlock the spend-to-save deadlock, but it was only once we started looking at the economic impacts of some projects using BERRI that we had clear evidence that we could save money whilst making services better, and on a fairly substantial scale. Our pilot in Bracknell Forest saved £474,000 in the first 12 months whilst making services better and improving the outcomes for the young people involved. And that was just a small scale pilot within a single local authority.

After so many years of being told that improving outcomes whilst saving costs would be impossible it sounds unlikely, but it is true. We made life better for the children involved – in some cases in ways that entirely changed the trajectory of their lives – whilst reducing costs for the local authority. The savings generated would be enough to fund services to address the mental health needs of all Looked After Children whilst still lowering the overall cost of Care. I’m not prone to hype, but that feels pretty extraordinary! Importantly we did it whilst also making life easier for the carers, professionals and placement providers involved. So it is no great surprise that we are now working with many Local Authorities to scope out and deliver wider scale projects.

So, what are we doing that is different? And where do the savings come from? Using BERRI we are identifying psychological needs effectively, and then addressing them early. For some young people that leads to significant change in their behaviour, risks or mental health, that then opens the door to different placement options, and for a small proportion of children the placement costs are substantially reduced. I’m not talking about forcing children in residential care to move to foster placements for financial reasons. I’m talking about better identifying the types of placements and services that young people need. For some, that will mean that they get to access residential care without having to break down a long series of foster placements to do so. For others it will mean that they get access to much increased mental health input, or specialist services. For many it will mean helping their carers to better understand their needs so they can make minor adjustments to the day to day care. But for some children it can open (or reopen) the doors to a family placement.

It may also have an impact on their longer-term trajectory, as it is well known that addressing mental health needs in childhood is easier and more cost effective than trying to address the difficulties they go on to develop in adulthood if these needs are not addressed. Using the BERRI helps carers to see behind the presenting behaviours and to recognise emotional, relational or attachment needs, or feel empowered to support these more empathically. Importantly, it can evidence the impact of the great work that many carers and organisations are doing already to support children by showing the changes they are making over time. It can help to set goals to work on, and to monitor what is and isn’t working effectively to create positive change. BERRI also helps to pick up learning difficulties, neurodevelopmental difficulties and disorders, so that children can then be more thoroughly assessed and care and education can be pitched appropriately.

We are also learning from our increasing data set what scores are typical in different settings, how individual children compare to the general population, and which variables are important in preventing negative outcomes in adulthood.

I sometimes use the metaphor of the cervical cancer screening programme. At a cost of around £500 per woman each 3-5 years, the screening programme prevents 2000 deaths per year. About 5% of women screened have abnormal cells, and 1-2% have the type of changes that are treated to reduce risk. As a result women who are screened are 70% less likely to get cervical cancer, which has an enormous human cost, but also costs £30,000+ to treat. Screening has saved the NHS £40 million. Most importantly it has led to the discovery that the human papillomavirus is significant in the development of cervical cancer. This has led to preventative treatment programmes with 10 million girls in the UK receiving the HPV vaccination. This has reduced the rates of cervical cancer (with 71% less women having pre-cancerous cervical disease), as well as preventing genital warts (by 91% in immunised age groups). It also has the potential to reduce other forms of cancer, as HPV is responsible for 63% of penile, 91% of anal, and 72% of oropharyngeal cancers, with this and the importance of herd immunity leading to the decision to immunise boys as well as girls in many countries.

I would argue that the case for psychological screening, particularly in population groups that have experience trauma, abuse or neglect, is even stronger. More than half of children in Care have a diagnosable mental health condition, and half of the remainder have significant mental health need that doesn’t reach diagnostic thresholds or doesn’t fit into a diagnostic category. They also go on to higher risks of a range of negative outcomes than the general population, including having a higher risk of heart disease, cancer, strokes, fractures and numerous other health conditions, as well as more than fifty times higher risk of homeless, addiction, imprisonment, requiring inpatient mental health care, or having their own children removed into Care. Like cancer, these have an enormous human cost on the individual and their network, and they also have a huge financial cost for the public purse (some estimates suggest £2-3 million per young person leaving Care, when including lower contributions to tax, increased benefits and the cost of services). If we can understand and address the issues that lead some young people down these more negative paths, and address those needs as early as possible in their lives, hopefully we can increase the proportion of young people who survive difficult early lives and go on to healthy happy adult lives.

If you want to learn more about BERRI and the impact it can have on your services feel free to get in touch. Or you can come and learn more about the pilot in Bracknell Forest and the larger scale projects we have started to expand on it, as I am presenting at the NCCTC next month with Matt Utley from the West London Alliance.

How not to apply for a job in psychology

I’ve been shortlisting for a new post today, as we’ve already received 43 applications for the advert I put up yesterday morning*. For a profession in which there is a narrative that prestigious Assistant Psychologist posts are almost impossible to get, the quality of applications is surprisingly poor. I don’t mean that the applicants themselves are surprisingly poor, as they seem to generally be alright, but the way they have applied for the post is, for far too large a proportion of those applying, pretty disappointing. It isn’t going to affect the outcome of the process, as there are some really good applications so we won’t have any trouble finding enough to interview, but there are far too many people who rule themselves out of the running unnecessarily. Many of these applicants might be quite good, but their applications fall far short of my shortlisting criteria for really obvious and easily avoidable reasons. That means that for people who do follow a few simple tricks** you greatly increase your chance of successful applications – not just in my post, but in any application within the field of psychology, and probably most of the advice will generalise to other job applications too.

Before you think that I’m a control freak with unreasonable expectations of applicants, please remember that the context is that 70+ candidates will apply for my vacancy before I close it, and NHS posts will typically attract 100-200 applicants within a short period of time, leading some to close in just a few hours. The balance of supply and demand here means that it’s a shortlister’s marketplace, and only the best applications from the best applicants will lead to an interview. That means that qualified CPs selecting for AP posts have to set high standards to let them narrow down the number of applicants quickly to a manageable amount that they can then shortlist in more detail. And having spoken to many other people who have been responsible for shortlisting similar posts and seen the posts on the thread on this topic on the clinpsy forum, my expectations and frustration with candidates who fail to do the simplest things to present their application properly are echoed by many of my peers.

Whilst these posts are particularly competitive and the application process has some sector-specific features, like the nature of GBC, and the relative values given to particular kinds of experience, what I am talking about are basic job seeking skills that should be taught by every career service or recruitment website. Not only that, but if you do a search on clinpsy you will see that the expectations held by people shortlisting for AP posts are clear, and there is a lot of advice available on this topic in the public domain. We are not expecting people to crack some secret code or have access to hidden insider information: Most of the things that would make the difference are things that require common sense and a bit of effort. My main grumble is as simple as people not reading the instructions on how to apply that are given in the job advert and firing off applications that aren’t specific to the post or don’t contain the required information, or that are really badly presented.

When it comes to my current post I’m not even asking anything too onerous. I haven’t set a task or asked anything unusual. I just want candidates to send a short CV and a covering letter saying how you fit the requirements of the post, with details of two referees. Surely that’s the minimum expectation when applying for a job, and pretty parallel to the NHSjobs expectation of giving education and employment history and then writing the supporting information and references? Yet a significant proportion have submitted applications with no covering letters, no references, or no information about why they want the job or are suited to it. To me that’s like going fishing but not taking a rod or a net.

In terms of essential criteria I’ve asked for a degree conferring GBC at 2:1 or better (or a degree level qualification in statistics or research), along with a driving license (or a transport plan for candidates with a disability to be able to complete the job). Yet many applicants have told me they will complete their undergraduate degree this summer, or don’t have a driving license. There are international applicants who haven’t shown me they can lawfully live and work in the UK. There are then applicants who haven’t given me information I need in order to see they meet my essential requirements. Perhaps they qualified abroad or with joint honours and they haven’t told me that they have GBC. Several haven’t given me a degree grade. Others might tell me that they had a particular job, but not give the hours or the dates so I can’t see how much experience they gained.

The process has really taught me how NOT to apply for a job in psychology, and I thought that might be expertise worth sharing. If you follow the advice I’ve numbered below, you too can be confident that you will maximise your chance to not secure a post!

So my first set of tips on how not to apply for a job are:

  1. Apply for jobs where you don’t meet the essential criteria
  2. Do not read the instructions on how to apply
  3. Do not write a covering letter (or supporting information section) at all
  4. Do not specify your degree grade
  5. Do not mention if you have GBC, even if you have an atypical qualification
  6. Apply from abroad but don’t worry to mention that you have the right to live and work in the UK
  7. Don’t tell me whether posts were full time or part time or the dates when you worked there

The next issue is that many (and in fact probably most) applications don’t tell me why you want this particular job, or how you meet our person specification. They fire off information that tells about their experiences and skills, but does nothing to show how they meet our shortlisting criteria, which are spelled out in the person specification. Few have told me why they want this job in particular as opposed to any job with an AP title or a CP supervisor. Some tell me about their aspirations to gain a training place and/or to have a career in clinical psychology, but (whilst I am aware that the post is a good developmental opportunity and I’m happy to support the successful candidate to develop) I’m not recruiting someone to help them achieve their aspirations. I’m recruiting to get a job done within my team, and their aspirations don’t tell me why they will be better at that job than the other 30+ people who have similar aspirations.

A significant proportion of applications consist of just a CV, perhaps with a very brief generic covering note. Many look like a mass mailing that the candidate sends out to every job listing that contains particular keywords. The result is that they feel like someone reading me a script to try and sell me double glazing or PPI claims without knowing anything about me – they have invested minimum effort but hope that if they apply to enough posts one might bite. In fact, many applications feel like they’ve taken less time to send out than they would take for me to read, and the impression given to the short-lister is that the person doesn’t care about the post at all.

Maybe it’s something about the internet age that people expect to be able to apply for a post with just a couple of clicks, like putting an item on an online store into their basket and then clicking to check out. If you had to invest the effort in phoning up for an application form and then filling it in by hand, as you did when I applied for my AP post in 1995, it might seem more obvious that you needed to make that effort count. But even then not every candidate would explain why they wanted the post. However the internet age also makes it easier to cut and paste the right chunks of information or to edit existing text. So it also makes it easier to tailor an application to a specific post.

So my next set of tips on how not to apply for a post are:

  1. Don’t read the job advert – the job title, pay and location are all the information you need
  2. Fire off a generic CV with no information about why you want the post or how your skills are suited to it (for bonus marks express interest in a different client group or service)
  3. Don’t even worry to read the person specification, that’s not important
  4. Don’t tailor your application to the job, just send the same application out to every post, regardless of the context or population.

The other big advantage is that the internet lets you check spelling and even grammar, so you really don’t need to submit applications that are peppered with typos and spelling mistakes. If you are dyslexic, get someone else to check it before submitting. If you feel too much time pressure to delay individual applications for proofreading then prepare the content you will need to configure most applications in advance so you can get someone to proofread your main blocks of text in advance. Word processing software also lets you count the number of characters, words and pages before you paste content in to your application, so you can easily follow any specified requirements. Which is why it is so puzzling to get six page CVs when I set a limit of two.

There are then other issues with how people present their applications. I get that pasting a CV into a recruitment site can mess with the formating, but you can normally use a preview feature to get the chance to see how it will appear to a recruiter, so it is worth checking. Simplify layouts and fonts and remove massive gaps that appear so that the CV looks neat and tidy. Keep it as short as possible. If I can write my CV on two pages, having worked in psychology for 24 years, managed teams in the NHS and now running my own business, I’m pretty sure that you don’t need six pages by the age of 23. And I’m sorry to break it to you, but I don’t care what your responsibilities were when you worked in that shop, or pub, or holiday resort in the summer before your degree. If you really want to mention it, I’m fairly sure one line would cover it. Otherwise it looks like you can’t prioritise – which is off-putting because being able to pick out the most salient information is an essential skill when deciding what information needs to go into a report.

So my next set of tips on how not to apply for a post are:

  1. Make lots of typos, and ensure to include as many spelling mistakes, punctuation errors and examples of poor grammar as possible (for bonus points, you could spell the name of the organisation or short-lister wrong, or try some text-style abbreviations)
  2. Lay your CV or application out so it is as unintelligible as possible, and definitely don’t check how it will appear in the application system
  3. Don’t worry about any requirements with regard to length, more is always better
  4. Put in lots of information about irrelevant experiences, such as work in retail and hospitality

I hope this blog doesn’t seem like I’m putting people who are just starting out in their psychology career down, or criticising those who have applied in a hurry for fear of the post closing before they have time to submit anything at all. My goal is entirely more positive – to share how simple it can be to make that impossible aspiration of gaining interviews for AP posts come true. There are certain really simple behavioural changes that can remarkably increase your odds of success.

So what can I do to improve my chances of gaining an interview?

First, apply to non-NHS job vacancies. It takes a little more effort to find them, and the quality can be more variable. However, they are a great foot in the door, and much easier to secure than their NHS equivalents as they tend to have lower numbers of applicants and to stay open a bit longer. If an NHS AP post means you have a 1 in 50 chance of an interview, a post outside the NHS might increase your odds to 1 in 15 for a fairly popular post, or even 1 in 3 if the post is only advertised on a company’s website and social media and not on a major recruitment platform. Yup, that one simple trick** can increase your chances by a factor of five!

Second, follow the instructions. Read the advert carefully and do what they tell you to do. If they ask for a two page CV make sure that you send one the right length. A 600 word essay? Well worth the effort, as sending it will double your chance of success compared to applying to a post without this requirement, as fewer other applicants will make the effort, whilst sending an application without it is posting your application straight into the no pile.

Third, tailor every application to show how you meet the person specification for that particular job, and to show you understand and are enthused about what the job will involve. Ideally you need to respond to every point of the person spec in a way that is clear and obvious to the shortlister, and probably in a similar order to that used in the specification. If they want a 2:1 or higher that confers GBC then you need to give your degree grade and specify it confers GBC, rather than assuming that the shortlister will know or be willing to check on Google whether this is the case. If you are applying from abroad or have international qualifications then it is worth stating whether you have the right to live and work in the UK, and explaining the scoring system and/or the UK equivalent of your degree grade.

Fourth, pick your battles. It is better to write fewer applications but to give each one more time so that it is of really good quality and tailored to the particular job than it is to send out hundreds of generic applications. Choose posts that you are enthusiastic about rather than applying to every AP post you see. Think about whether the location can work for you and whether you have relevant experience and/or transferable skills to bring. Make sure every application is up to the highest standards, even if this means they will sometimes close before you submit them***. In such a competitive field it is probably only worth applying for posts where you meet all the essential criteria.

Finally, check your working. Make sure you have spelt names and organisations correctly, and not made any silly typos or cutting and pasting errors. If you can, get someone else to read your text so you can get feedback on how to improve it. Even if that isn’t in time for the application you wrote it for, it will mean you don’t make the same mistakes next time. Preview the application to check the formatting if this is possible.

Then fire it off and cross your fingers!

 

*I’ll be reading more over the coming days too as we normally keep the advert open for a week or 75 applications, whichever comes first. Edited to add: We closed after 5 days and received a total of 86 applications. We invited five people to interview.

**cliche internet phrase

***In this circumstance it is worth sending an email to the appointing officer or point of contact given in the advert explaining what happened and attaching your application. They may consider it anyway, and even if they don’t you risk little by trying.

The misrepresentation of evidence

About a week ago I was involved in a heated twitter debate about this blog post. I felt, as I said on twitter and in my extensive comments about the blog, that it entirely misrepresented the evidence about Adverse Childhood Experiences by implying that because of risk multipliers within particular population groups, certain negative outcomes were almost inevitable for people with multiple ACEs. The author repeatedly asks rhetorical questions like “If 1 in 5 British adults said they were abused in childhood in the last CSEW (2017), why hasn’t our population literally collapsed under the weight of suicides, chronic illness, criminality and serious mental health issues?” Likewise, she asks how anyone can be successful after childhood abuse if the ACEs research is correct. I replied to explain that this simply isn’t what the data tells us or what risk multipliers mean, so the exceptions are expected rather than proof the finding is incorrect. For example the claim that a 1222% increase in the risk of suicide amongst people with 4 or more ACEs meant these people were doomed, in reality means that the odds increase from 1 in 10,000 to 1 in 92, meaning that 91 of every 92 people with 4+ ACEs do not die by suicide.

ACEs are a very useful population screening tool, and have provided incontrovertible evidence of the links between traumatic experiences in childhood and numerous social, psychological and medical outcomes that has been highly informative for those of us designing and delivering services. To me it seems like an example of how a simple piece of research can have a massive impact in the world that benefits hundreds of thousands of people. Yet that blog repeatedly implies ACEs are a harmful methodology that “targets” individuals and to is used to “pathologise and label children, arguing that those kids with the high ACE scores are destined for doom, drugs, prison, illness and early death”. It has been my experience that ACEs are used not to pathologise individuals, but to to highlight increased vulnerability, and to identify where there might be additional need for support. For example, I have used this data to argue for better mental health services for Looked After Children.

I felt that the repeated misrepresentation of the maths involved in interpreting risk multipliers undermined the entire message of the blog, to which I was otherwise sympathetic. (For the record, it is entirely appropriate to highlight bad practice in which it seems certain professionals are applying ACE scores to individuals inappropriately, and making people feel that their life chances are restricted or their parenting under scrutiny purely because of their childhood experiences of trauma). But unfortunately the author took my polite, professional rebuttal of elements of her blog as a personal attack on her – to the extent that she misgendered and blocked me on twitter, and refused to publish my response to her comments about my reply to her on the blog. That’s a shame, as the whole scientific method rests on us publishing our findings and observations, and then learning from the respectful challenge of our ideas by others with knowledge of the topic. But I guess we are all prone to defending opinions that fit with our personal experience, even if they don’t fit with the evidence.

Thinking about how uncomfortable it felt to see someone I considered to be a peer whose expertise I respected misrepresenting the evidence and being unwilling to correct their misconceptions when challenged, but instead trying to discredit or silence those making the challenge, it struck me that this was an example that highlighted a wider issue in the state of the world at the moment. Evidence is being constantly misrepresented all around us. Whether it is the President of the USA saying there is a migrant crisis to justify a wall (or any of the 7644 other false or misleading statements he has made in office) or the claims on the infamous big red bus that Brexit would give the NHS £350 million per week, or Yakult telling us their yoghurt drink is full of “science (not magic)” now that they can’t pretend live cultures are good for digestive health. There are false claims everywhere.

I stumbled into another example just before I started writing this blog, as I (foolishly) booked accommodation again through booking.com, despite the horrible experience I had last time I tried to use them (which remains unresolved despite the assurances from senior managers that they would reimburse all of my costs). The room was terrible*.

So I felt like I should be able to reflect my negative experience in my review. But oh no, Booking.com don’t let you do that. You see, despite seeing that properties appear to have scores out of ten on every page when booking, you can’t score the property out of ten. What you can do is to determine whether you give a smiley that ranges from unhappy to happy for each of their five ratings (which don’t, of course, include quality of sleep or feeling safe). So if you think the location was convenient, the property gets a score above five out of ten, no matter what other qualities mean you would never wish to sleep there again. But worse than that, the Booking.com website forces reviewers to give a minimum length of both positive and negative comments, but only displays the positive comments to potential bookers. So my “It was in a quiet, convenient location” gets shown to clients, but you have to work out how to hover in the section that brings up the review score, then click the score to bring up the averages, then click again to access the full reviews, and then shift them from being ranked by “recommended” to showing them in date order to actually get an objective picture. Then you suddenly see that at least half the guests had terrible experiences there. However, there is no regulator to cover brokers, and fire regulations and legal protections haven’t caught up with private residences being divided up and let out as pseudo-hotel rooms.

But just as Boris has faced no consequences for his bus claims (even though he stretched them further still after the ONS said he had misrepresented the truth), and Trump no consequences for his lies, and the consultants selling contracts worth hundreds of thousands of pounds of public funds to children’s social care departments proudly told me they didn’t care about evidencing their claims, so the world carries on with little more than a tut of disapproval towards people and businesses who intentionally mislead others. Maybe I’m in the minority to even care. But I do care. I feel like it is the responsibility of intelligent people and critical thinkers, people in positions of power, in the professions and particularly in the sciences, to ensure that we are genuinely led by the evidence, even if that makes the picture more complicated, or doesn’t confirm our pre-existing beliefs. To counteract this age of misinformation, we all need to be willing to play our part. That is why I have always placed such a focus on evaluations and research, and have developed my screening tools so slowly and thoroughly, despite the fact that potential customers probably don’t see this as necessary. I believe that as much as possible, we should be promoting the value of evidence, educating the public (including children) to be able to think critically and evaluate the evidence for claims, and stepping up to challenge misleading claims when we see them.

*I booked a room in a property in London which they have euphemistically called “Chancery Hub Rooms” to stay over whilst I delivered some training in Holburn. It wasn’t a hostel or a hotel, but just a small terraced house. This time it had keypad entry to the property and to the individual room, which is a system that I have used successfully several times in Cambridge. Unfortunately it didn’t work so well in London, as they changed the codes twice without informing me. Once this resulted in locking me out of the room on the night of my arrival (and meaning that the beeping on the door as I tried the various codes they sent me woke the lady in the neighbouring room, due to the total lack of sound insulation in the property) and then by locking me out of the property the following evening, when all my stuff was locked inside. It also had glass inserts above the room doors that meant your room lit up like Times Square when anyone turned the landing light on. I then discovered that the building (which I already recognised to be small, overcrowded and not complying with fire regulations) had walls like cardboard, when the couple in the next room had noisy sex, followed by noisy conversation and then a full blown argument that lasted from 3am to 4am – despite me eventually in desperation asking them quite loudly whether they could possibly save it for a time that wasn’t keeping everyone else in the building awake. Of course Booking.com didn’t see it as their problem, and the property management company just blamed the other guests for being inconsiderate.

The elephant in the room: Mental health and children’s social care services

I heard a few months ago that the Housing, Communities and Local Government Select Committee were undertaking an inquiry to look at the funding of local authorities’ children’s services, and thought that sounded like an interesting topic that might relate to my areas of interest. I therefore met with a local MP about the topic, contributed to the BPS response to the inquiry, and (on the request of the committee) submitted my own response in relation to my innovative work with BERRI. I have subsequently been called to give evidence in person to the enquiry in a few weeks time.

Given I’ve been so immersed in this issue it seemed a good topic for a blog. I’m going to start with the evidence that this sector is in crisis, before thinking more about what a clinical psychologist like myself can contribute to addressing elements of this need. Hopefully I can then write another blog in a few weeks time to talk about my experience of giving evidence, and report back about whether the politicians grasp the issues and appear motivated to do something about it.

It didn’t surprise me that this was an issue that the government wished to give more scrutiny, given the steep increase in need in this area over the last decade, whilst funding for local authorities has been substantially reduced by the government’s austerity agenda. Human distress and unmet need rarely seems to gain political attention unless it is in such a crisis that the public are aware of the issues, or it has financial implications for the public purse, and children’s social care has suddenly hit both of those thresholds in the last year or so. 

A number of factors have combined to increase need in children’s services. This includes growing awareness of child abuse and its impact (particularly emotional abuse which has long lagged behind the more tangible forms of abuse), along with reduced stigma in disclosing having been abused (due, for example, to the publicity surrounding the Jimmy Saville scandal, the various institutional abuse enquiries, and the #metoo movement) and a reduced tolerance for forms of abuse that had been normalised or ignored in the past (due to cases like Baby P and the Rotherham child sexual exploitation trials, and subsequent prosecutions in many other areas). A lot of teenagers who had been allowed to remain in unsuitable living circumstances because of the belief that they would “vote with their feet” if removed are now appropriately protected and brought into Care, perhaps because of some precedent setting cases in which people have taken successful legal action against local authorities and have been compensated for failures to protect them in childhood. This includes an enormous legal settlement for two Care leavers from Jersey, who have received tens of millions of pounds compensation.

Children in Care are also entitled to stay in their foster placements up to the age of 21 where they want to and it would be beneficial for them, and to have support after leaving Care from a personal advisor until the age of 25. Another pressure is the reduced use of secure units on welfare grounds, and a reduced willingness to incarcerate children in institutions for recurrent minor offending. The increased stress, shame and social hardship of benefit changes and increases to cost of living has led to move children growing up in poverty, and more families developing the risk factors that can cause harm to children, such as drug or alcohol use, mental health problems, domestic violence and family breakdown. This has had a particularly negative impact in families in lower socioeconomic groups.

It is therefore unsurprising that over the same period of time the demands for social care services have risen steeply. Over the last decade there has been a 9% increase in referrals to social care and numbers of children considered in need, but there has been a 84% rise in child protection cases, and 26% more children are in Care. This creates a lot of additional workload for children’s services, with a 122% increase in demand for section 47 enquiries, and a 125% increase in Care Proceedings (as less children are now informally Accommodated with parental consent). Yet the budgets have shrunk, so there is no resource available to meet this need.

The financial picture is genuinely shocking, and yet it has hardly made the news (perhaps because looking at the numbers is considered too technical or boring for the lay public, and the political and news agenda has been hijacked by the continuing debacle of Brexit). But reviewing the figures makes sobering reading. The cuts to local authorities since 2010 are unprecedented. The National Audit Office highlighted the extent of the shortfall in their report on the financial sustainability of local authorities published last year. They point out that central government spending on social care has halved. This has been masked by changes in how funding is delivered, and some additional funds from council tax being made available to spend locally, but the cuts are still enormous and amount to a real terms reduction of nearly one third of the entire budget for local authorities, but the burden is again being disproportionately felt in more deprived areas.

Such cuts are unrealistic and unsustainable, as they make the total budget too small to cover anything other than statutory services, which are legally protected. This means that councils have no means to make ends meet without dipping into their savings. The report shows that two thirds of local authorities had drawn from their reserves by 2016-17, so there is an ever decreasing amount left in the pot for contingencies, and the audit office predicted that 11% of authorities will empty that pot by the end of this financial year. Councils are having to sell off properties and come up with increasingly radical plans to try to fulfil their minimum duties. Recently Northamptonshire County Council had to declare themselves bankrupt as they had no means to cover statutory services from the available budget.

This mismatch between demand and resourcing has led to enormous cuts to non-statutory services, with two thirds of the spend on preventative and community children’s services disappearing. This means that, as with mental health, there is a minimal set of brief services delivered for milder or less entrenched difficulties, but that there is then an abyss in which no services are available until they reach the threshold for the crisis-focused specialist services – which are expensive and time-consuming to deliver and can’t keep up with demand. The focus has moved from collaborative work to assessments and interventions that are perceived as the end of the line, despite the absence of the precursor interventions that might have enabled change.

To me, the elephant in the room when it comes to children’s social care is mental health need. I don’t just mean the clean single-condition, diagnosable treatable mental health need that gets through the doors to CAMHS. That’s the need up on the sterile concrete plains of mental health research that Prof Miranda Wolpert describes so well. I mean the real messy need down in what Miranda calls the swampy lowlands where real complex people live in varied circumstances, where numerous issues intersect to create barriers in their lives that are not straightforward to address, and do not fall into the simple diagnosis to treatment pathway that currently gets through the doors to CAMHS. That’s the need that determines the outcomes for these children, and the pathway on which they leave Care and try to negotiate adulthood. It is that need which determines whether they can go on to happiness, employment and family life or whether they become one of the Care leavers who end up facing prison, homelessness, mental health problems, addiction, conflict and/or their own children going into Care.

So what are these broader mental health needs? In my experience, a complex and interwoven picture of trauma, adversity, behaviour problems, attachment difficulties, developmental disorders or delay and mental health needs is typical of children in Care or receiving social care services. As well as the traditional “mental health” needs of anxiety and depression I see a much broader picture that is expressed in a variety of ways. Some children act out with their behaviour, others withdraw and show signs of emotional difficulties (including low mood, poor self-esteem, and a lack of positive identity or perception of belonging). They often struggle to form healthy relationships/attachments to others, and can present a risk to themselves and others. They have an increased prevalence of conditions like Learning Disability, Autism, ADHD, or psychosis that add an additional layer of challenge in standard services effectively meeting their needs. That is why my BERRI assessment system attempts to cover all of these areas.

Seen as a group, children who are Looked After have high levels of mental health difficulties (45% have a diagnosable condition, and over two thirds have significant mental health need), so it would be easy to blame the Care system. However, this extraordinary level of need is predominantly caused prior to them coming into Care. It is well established that Adverse Childhood Experiences lead to multiple layers of vulnerability, and these are very prevalent for Looked After Children (my own research suggests an average of 4 historic ACEs per child, along with 2 current vulnerability factors at the point they come into care, such as involvement in gangs, sexual exploitation, school exclusion or the criminal justice system). Looked After Children are in the vast majority traumatised children, who have experienced abuse and/or neglect. But these problems don’t occur in isolation. They are contextually embedded. Children in Care come disproportionately from families that experience the adversities of poverty, crime, family breakdown, and poor housing. They are more likely to be born to parents who have lower education, higher risks of unemployment, and a higher incidence of mental health problems, substance misuse, domestic violence and a history of abuse or neglect in their own childhoods. As a result, their parents are less able to provide safe and stable care. Patterns of difficulty often carry through many generations of the family, and the problems they face are a symptom of our increasing social inequality. 

However, CAMHS are not really set up to meet these complex and interwoven needs, and cut off at 18 years of age, whilst children can stay in care until they are 21 and receive leaving care services until the age of 25. They also have ongoing needs that will need to be revisited over time as they develop or different themes emerge as they enter different life stages or face different challenges. It might be that a dental care model, in which there is long-term oversight but with responsive services as and when they emerge works better than the time-limited episodic care that is currently on offer. Likewise services need to be embedded so that they collaborate with placements and other support services, rather than stand in isolation.

The wider context of the underlying contextual and vulnerability factors mean that treating symptoms or even specific conditions might be an ineffective model of intervention. We need to think back to Maslow’s hierarchy. These children first and foremost need their basic needs met, and to have reliable food, shelter and warmth. They need safety and security, medical care and an environment that doesn’t contain ongoing risks. They need opportunities for identity and belonging, such as education, employment, hobbies, peer relationships, and family. They need intimacy and trust in their friendships, sexual/romantic relationships and relationships with carers. When that is reliably in place they need opportunities for achievement and being valued, so that they can gain self-esteem, confidence, status, responsibility and individuality. The icing on the cake is then self-actualisation, the chance to explore creativity, set goals, reflect on morals and values, and feel purpose and fulfilment. Mental health needs only fit in mid-way up that pyramid. We cannot expect a child to have a positive outlook and good coping strategies and social skills if they are not in a safe environment, don’t have their basic needs met, or cannot trust those around them. To see the point of going along to a therapist takes enough self-esteem to believe you deserve to feel happier, and you then need the organisation and social skills to get there, and the trust to confide your story, or a carer who will advocate for you and help you to achieve these steps. There are many building blocks that need to be put in place by the caregiver and environment before therapeutic interventions are possible, and it may be that when we get these other elements right, the child is able to recover using their own resources and that of their caregivers, without ever seeing a therapist.

My perspective is that if we can help to identify needs of children as early as possible and skill up the caregivers and the systems around the child, we can make the most impact. That is why I have increasingly moved from working with individual children to working with their caregivers and the systems that surround them, and have developed the BERRI system to identify needs and help carers understand them, as well as developing and delivering training to help carers and professionals understand the needs of the children and young people better. It doesn’t have the depth of working psychologically with a single individual, but it has the scope to make impact on a much wider scale, and it fits better with my personal strengths and interests. As I’ve said before, I’m not the most patient therapist to walk a long journey of recovery or personal development with a client, but I do have strengths with assessment and evidence-based practice.

My aims have always been to address human needs. I believe that Clinical Psychology in its simplest form is an attempt to make people happier and more able to lead fulfilling lives, and that is what drew me to this profession. And within that broader mission, my focus is to work with the most vulnerable members of society at the earliest possible point in the lifecycle, which has brought me to working with Looked After Children and the broader population of children and families receiving (or in need of) social care services. Recognising the mismatch between the level of need and the resources available to meet that need has increasingly led me to focus on systemic and population level interventions. Rather than drowning in the burnout that comes with trying to solve an overwhelming problem, I’ve tried to find a niche where my skills can make an impact. Having looked at this population group from multiple perspectives, and tested out projects in various settings, I have become increasingly persuaded that there is scope to make positive changes through the use of better systems to identify need, and increased clinical governance over the choice of placements and interventions. 

I have tried to develop practical, cost-effective ways to make a difference, and to gather evidence of their efficacy. I have then tried to share my findings, and what is already known from research, with the widest and most influential possible audience. That is why I have given so much of my time over to writing best practice papers and contributing to policy. Through these experiences I have gradually learnt to shape the messages I share to make them relevant and understandable to various audiences. After all, whilst most of psychology seems common sense to those of us working in the profession, once you have learnt about the main findings and the methodologies for gathering knowledge, to lay people (and professionals, commissioners and politicians) it might seem very complex and unfamiliar. Over time I have learnt that being able to articulate the financial benefits of improving people’s lives helps to get decision makers on board. So my goal in responding to the enquiry was to explain both the human and financial case for greater psychological input for children receiving social care services. I don’t know how well I have achieved that, but I’d be interested in your thoughts and feedback.