Author: clinpsyeye

clinpsyeye https://clinpsyeye.wordpress.com I'm a Consultant Clinical Psychologist working in the UK. After 17 years in the NHS I left in 2011 and set up my own company. We have subsequently taken on the challenge of introducing tools to help identify the psychological needs of Looked After Children and track how they change over time (see www.BERRI.org.uk). We hope that regular use of outcome measurement can improve the quality of services and the life chances of complex children. I have written a book called 'Attachment in Common Sense and Doodles' published by JKP, which tries to make current scientific and therapeutic knowledge about attachment and chronic developmental trauma accessible for adoptive and foster parents, residential care staff, professionals and lay people. I train health, social care, legal and other professionals about attachment and the impact of abuse, trauma and poor early care. Over 1000 people have attended my two-day training for residential care staff, and I’ve trained hundreds of adoptive and foster parents to "manage behaviour with attachment in mind”, as well as training other professionals to deliver this content as a group program. I’ve also done a number of keynotes, workshops and plenaries at conferences. In my spare time, I run www.clinpsy.org.uk which is an internet site and forum for aspiring and practising clinical psychologists. We publish an e-magazine called Aspire periodically, for which I am editor. I have also done a lot of expert witness work for the family courts sat on various committees and been involved in lots of policy work. However, I am trying to reduce this element of my work to focus on doing more research, training and consultancy. I want to expand my time for writing (of academic papers, psychology-related books and a novel), and I am currently experimenting with blogging and social media as means to disseminate psychological thinking.

Hindsight and reflection

When I watched The Usual Suspects, the twist at the end made me immediately re-watch the whole film. The extra bit of knowledge meant the same information from the earlier plot had entirely different meaning. The same thing happens when you realise someone has lied to you, or manipulated you for some secondary gain – you suddenly need to reappraise all the prior interactions you have had in light of this new insight. It is inevitable as we go through life that we learn additional information that helps us understand things in more sophisticated ways. Just as we learn that our parents are flawed human beings, rather than always right and almost omnipotent, a lot of relationships transpire to be less perfect when the first thrill of connection wears off. It can be quite a challenging process to understand why you were fooled, what you should have noticed, and how you could have avoided the bad feelings that come with realising all was not as it seemed.

In one chapter of my book I talk about the poem “Holes, An Autobiography in five short chapters” by Portia Nelson. It is a nice summary of the patterns we can all fall into, and how it is only reflection and insight that lets us climb out, and eventually learn to avoid falling into similar holes in the future. I found it really helpful realising that there were certain “holes” that I recurrently fall into. In particular, I was susceptible to one when others seem to need my help and support, but keep on taking without recognition of the value of that help or any cost it has for me, until I feel exploited. An early example was a student who volunteered when I was an AP, who I supported to apply for similar posts and to get onto clinical training, before becoming aware she had presented some of my work as her own, and named me as a reference for a job she had been fired from (when I wasn’t her supervisor and didn’t work there, in the expectation I’d say only positive things).

Related to this, perhaps, is my sense of myself never living up to the high expectations I set myself. It means I often assume I’ve done something wrong, until I find out that the other person is getting me muddled up with someone else, or has put the wrong time for the meeting in their diary. I feel acutely guilty if I take too long to write up the notes from a consultation, even if I’ve had time off sick or other crises to deal with. And I always first reflect on my part if there has been a misunderstanding (eg if the builder is asking for much more money than the written quote, and implies that we agreed additional costs for changes to the design – even though I know I would have kept track of that). It also made for very difficult dynamics with an AP who appeared really hard working and humble until I wrote them a reference for training, then started being increasingly critical and undermining, blaming me for their lack of progress in any of the tasks they were employed to do until I felt quite upset. It was only when I shared my feelings with trusted advisors and peers that I was able to recognise that the problem wasn’t with me. I then started to recognise I’d been gaslighted, and that if someone else makes me feel bad, I have no obligation to kept bending around them until they are satisfied.

Sometimes it isn’t new information about what happened or the other person’s motivation, but a new perspective or frame of reference that shows past experiences in a new light. I’ve reflected in past blogs about how what seemed like normal teenage boy behaviours, that were a socially acceptable way for them to show their interest in me (and portrayed in my peer group as something I should be flattered by) were actually quite inappropriate – unwanted, overly persistent and at times clearly non-consensual. Likewise, I learnt the term “stealthing” meant the guy at university who knew my consent was contingent on condom use, and made a show of using one but transpired not have to used it after the fact, was not just a selfish scumbag (as I thought at the time), but had committed a form of rape. The new insight gave a different perspective on past experiences that helped to bolster my trust in my own feelings and ethical judgements. And helped make me even more determined that I wouldn’t be complicit with these patterns again even if it means I sometimes have to risk looking emotional or being seen as a “difficult woman” when I assert my position.

From these relatively small examples in my own life, I also gained a new respect for the task of reprocessing past experiences for those who have lived through abuse and trauma. If a tiny piece of new information, or a new way of looking at things can throw my certainty about my past experiences into doubt and demand a high emotional load to process, how much more demanding it must be for those whose lives were impacted by much more serious or sustained experiences such as childhood sexual abuse, grooming, or coercive control in a relationship. It will take time and effort to reprocess their own story when they are no longer in the sway of the person who is normalising the abuse. But often we are also fighting against social norms (eg many women are socialised into accepting “grey rape” as being not the real thing, if they didn’t say a clear “no”, or were intoxicated, or went back to his place/invited him home/consented to kissing or prior sexual activity). The meaning of experience is very much in the eye of the beholder, and shaped by cultural narratives. And there are forms of cultural oppression that change our whole sense of self, such as messages from family or religious/cultural groups that lead to people not feeling able to show their authentic sexuality or gender identity (the latter issue somehow being co-opted by both TERFS and right-wing figures who see trans people as an easy target for their “culture wars”). Finding a safe place and social network in which to be your authentic self is so critical for our happiness. Even feeling okay about your body and appearance is a challenge for many people, and finding body positive role models and reaching acceptance of ourselves that isn’t conditional on weight-loss or conforming to popular beauty standards can be life-changing.

A similar shift of needing to reappraise the story by which I understand my experiences happened to me recently in terms of my own body and health. After some quite unpleasant side effects to coming off HRT, including excessive bleeding to the extent I ended up in A&E, I had an ultrasound that suggested I have adenomyosis – a thickening of the endometrium, where lining tissue is mixed in with the muscle wall. Reading up about adenomyosis I discovered that this could explain the nature and extent of the period pains I have experienced since adolescence. It might also explain my negative reaction to the Mirena/Jaydess coil (despite this being a recommended treatment for excess bleeding due to adenomyosis) and the problems I’ve had with menopause. It may also explain why I’ve been prone to gain weight, as excess oestrogen can increase fatty tissue and fatty tissue can increase oestrogen production. But the most striking new info for me was the fact it is associated with premature delivery – as I’ve carried a lot of guilt about not having managed to sustain the pregnancy with my twin daughters to full term, and I’ve never had an explanation for why this happened. So I’ve started to reevaluate what I thought were the truths of my own life and how my body operates. I’ll learn more as I follow up with the consultant gynaecologist next week, but it seems bizarre to have lived with something that has potentially had significant impact on me throughout my adult life without being aware of what it was. But women’s health has always been an area in which medicine has lagged, and for the most part when it comes to menstrual or menopausal issues we suffer quietly. I’ve blogged before about how we need to assert our needs, and yet here I am realising I haven’t done so, as I didn’t realise my experience wasn’t the norm until the symptoms became too intrusive to work around.

Health symptoms also remind us of our own mortality, and the privilege of being healthy and able bodied. Having to reappraise our plans in light of health challenges or functional limitations can be another trigger for reflective hindsight. As can the illness or death of a loved one – or a public figure like the queen. Health is not a meritocracy, and lifespan does not reflect the value of a person. We are not guaranteed to live the average lifespan. We may get more time, we may get less. If we knew today that our time was limited, would we look back and wish we had done things differently? If so, maybe it is worth reflecting on our priorities now, because time is always limited – even if I live another 50 years. I feel incredibly lucky to have spent over a quarter of a century feeling loved by someone I love, to have had the benefit of a supportive family, and to have wonderful children who I get to spend time with every day. So the big building blocks of my life are firmly in the right place. However, I’m sure that there are small changes that could help me to spend less time on work and trying to make the future opportunities we have better, and to focus on the joy available within each day. Reading back over this blog, which I started eight years ago, I can see progress in some areas (I’m much clearer about my values, and what I want to do professionally, and have a tighter focus in how I want to make impact in the world). But I also see themes where I identified the need to make positive change that are still pertinent in my life today. So I need to think why I haven’t been able to prioritise self-care more, or to get rid of the physical or metaphorical clutter in my life, and how I can make space to be creative, spend more time in nature and connect with like-minded others. Maybe I should get some more coaching or personal therapy to reflect on this.

Gaining insight about ourselves is a particular kind of opportunity to grow and learn. Whilst it can be challenging, that reprocessing of experience over time and with greater information is a core part of personal growth (and a key foundation of the scientific method – that as we understand the facts better, we look again at our working hypotheses and adjust them to fit the new information). Understanding ourselves better can help us reach greater happiness and self-actualisation, and also helps us to understand our place in relationships with others, and in the wider world. It is a key part of the journey towards both happiness and wisdom, and lets us hang onto our values, despite the storms of political decay, inequality and climate change raging around us, which could so easily lead to feelings of despair and helplessness. Maybe the key to happiness in challenging times like this is to reflect on the things that you can change, and find a way to not dwell too much on what you can’t.

I sometimes find it heartening to think about how each honey bee makes less than 1/12th teaspoon of honey in their lifetime, yet pooled together it is enough to ensure the future of the colony. It helps me to remember that to make the world better, you don’t need to solve the big stuff, just focus on doing your 1/12th teaspoon to help others. A bee won’t directly benefit from the honey she makes; instead, it will allow future generations to thrive after she is gone. This too is how we can change the world — by each doing the small things we can, and inspiring others to do likewise.

Playing the part: Some comments on political cosplay

Both Liz Truss and the disgraced PM have been pictured in the media cosplaying over recent weeks and months. Johnson dressing up as a fighter pilot, a soldier, a fishmonger, and in numerous hard hats and reflective jackets, and Liz Truss mimicking famous photographs and outfits of Margaret Thatcher have received the most coverage. But they aren’t the only ones. Priti Patel had her police jacket for her publicity shoots about immigration enforcement, and Sunak has been photographed in army camouflage, reflective jacket and hardhat, or white coat and mask during various visits, Sajid Javid likewise.

They are dressing up to play-act different roles, and carefully curating their image more generally (even when they are not overtly dressed up) to engineer public perceptions to create a desired public persona. Just as millionaire Nigel Farage likes to be pictured with a pint, play-acting an everyman whilst ranting about the elites (of which he is actually more representative), these outfits in which they don the trappings of those performing highly skilled, socially valued or manual jobs attempt to show that these posh self-serving elites identify with the working class and those who serve the country in the public sector that they are stripping bare. They want to look like they support the police, health, science, education, construction, armed forces by dressing up like them – but their actions say otherwise.

I suspect it is no coincidence that many actors have made it into positions of power (like Ronald Reagan, Arnold Schwarzenegger, Volodymyr Zelenskyy) and that politicians who wish to rise up the ranks seek out visibility on reality TV and panel shows (Johnson appeared seven times on HIGNFY, four as host). These opportunities don’t show how well they can do the job, or how well they understand key issues, but they try to make the individual likeable and human by showing their charisma and sense of humour. That plays well for those who like to be centre of attention and have learnt to entertain, but it is a poor metric for selecting people into positions of influence, where it could be argued that more serious skills (like getting on and doing a job, rather than doing something performatively or simply arriving to take credit when it is done) should take precedence. For example, Johnson ineptly mopping the floor at my local specsaver for the cameras didn’t mean that he took any helpful actions about flooding or understands the wider consequences of climate change. In fact, it merely illustrated that he is used to other people cleaning up around him, rather than doing so himself.

Over recent years, we’ve seen a move towards comments from the public and funny responses from social media becoming part of the content of news coverage and newspaper websites. The outfits, relationships and trivial events in the daily lives of celebrities are presented as headlines, alongside coverage of the war in Ukraine or the emerging international health risks from monkeypox. Superficial fluff that wouldn’t have been seen as worthy of coverage before is now everywhere, along with clickbait headlines driving traffic to advertising. News has to compete for attention more than ever before. Has reality TV and social media led to this shift away from issues of substance and judging people by what they do, towards celebrity and appearance? Or is it a deliberate tactic to make incompetence and corruption more palatable?

In Johnson’s case it not only seems intentional, but was a tactic he openly discussed in a newspaper column. The formula became wearily predictable: When news coverage about the government is negative, they create a “dead cat” story to change the conversation and focus of attention away from it. Most typically, if stories break that that he doesn’t like, he distracts attention by saying or doing something controversial. For example, when it came to light Johnson had promoted various women he has had affairs with for public funding or employment, demonstrating clear misconduct in public office, suddenly he was visiting Ukraine. Like Donald Trump, he also likes to create so much noise and controversy that he is always in the spotlight, but fact checkers and those who apply any other perspective are always one step behind and swept away in the next headline. Hence the litany of racist, sexist and homophobic quotes. You could even argue that some of the roots of the public vote for Brexit (compounded by Russian misinformation and the outright lies of the £350 million for the NHS paraded on the bus, and the racist posters of queues of refugees, and the fake threat of Turkey joining the EU) were in his made up stories about bendy bananas, condoms or vacuum cleaners being subject to EU red tape. These were amongst more than 500 misleading UK headlines about the EU prior to the Brexit vote.

But it isn’t just the stories that are weaving a fiction in which the public are encouraged to believe something other than the truth, it is the whole persona Johnson has created. Boris isn’t even his real name, or the one he uses with friends and family, but Alexander Boris de Pfeffel Johnson sounds like the posh entitled man that he is, not the the one he wants the public to see. It is well documented that he intentionally messes up his hair before TV appearances or being photographed, and he dons a silly costume for every possible publicity stunt, because he wants to be seen as that funny, harmless oaf and not as the dangerous corrupt risk to national security that appears if anyone pays enough scrutiny. In the case of the outgoing PM, it is hard to know what is beneath the construction of the scruffy buffoon he plays. He seems to have no sincerely held beliefs, to the extent he claims to have written both pro and anti-Brexit articles before deciding which one will serve him better to publish. The only constants that appear through reports about him over his professional life are his lying, his corruption and his infidelity.

So, when I see Liz Truss posing like a pound shop Thatcher, it seems to me to be a symptom of something bigger. Her history too shows weathervane opinions that shift according to what will help her access increased power. From her early Liberal Democrat politics, and her anti-monarchy speech, to her change of heart over Brexit, there is nothing that Truss will not 360 on if she thinks it is in her interest to do so. The latest shift to the far right with increasing racism and populist tax cuts that are likely to lead to both increased inflation and massive reductions in public spending is designed to please the Tory membership and secure her as the next PM. It shows she is cut from the same cloth as Johnson, and bodes badly for the country.

In some ways, the fact she is so unlikeable and insincere, coupled with the far right nature of her policies, might be helpful in the long term. The public are starting to see through the false promises of Brexit, and to see the harm that having such a self-serving government is doing to our NHS, the handling of the pandemic, our international relationships and standing in the world, and the cost of living. I hope that they will want future governments who care about standards of public life in the UK and recognise that self-interest by those with the most wealth and power harms all the rest of us, and the current incarnation of the Conservative party will never be electable again. Hopefully we are simply counting down until a general election, though I fear how much harm can be done in the interrim.

I’m also worried (after Trump and Brexit and the Johnson majority) that the public are too easily fooled by the characters that are being performed by those in and seeking power, and the biased coverage of the major newspapers. There is unprecedented lack of trust in politicians – which research suggests is not entirely unfounded. I’ve heard too many people say “but they are all as bad as each other” as if this government represents all politicians in the UK. The desperate headlines claiming Kier Starmer has millions of pounds of development land (rather than a field in which his mother keeps rescued donkeys) or that he also partied during the lockdown (rather than had a beer and takeaway where they had been working during election campaigning whilst restaurants and hotel catering were closed) seem to have made people think that nobody in politics is honest or genuinely cares about the issues affecting the population any more. I’ve even heard people equate Starmer having been honoured with a knighthood for his work as Director of Public Prosecutions to him being part of the crony establishment, like Lebedev and Johnson’s numerous other patrons who have joined the peerage.

I desperately want to believe that the next government will bring in immediate reforms to correct the course we are on. Some obvious changes would be to bring in electoral reform, to move away from the two party system in which most votes do not matter, towards a more representative system. They also need to make an independent committee to judge standards in public life, with the power to suspend and strike off any politician or public figure for gross misconduct. This could include sexual, criminal, professional or financial misconduct, serious or repeated lying, or making practical or financial gain for themselves, connected persons or donors. This should lead to prohibitions on second jobs consulting to businesses or working for them in the three years after leaving office, or on holding shares or interests in businesses that could be advantaged by their position or policy influence. I want to see immediate reforms to the House of Lords, striking out all recent appointments, hereditary peers, religious representatives and any member who has not participated sufficiently in the work of that office, and instigating transition to a second elected house which contains a wide range of subject experts. I also want to see stronger rules against misinformation, and support for the independence of the media (including the BBC and Channel 4). Social media companies should be made financially liable for harm caused through their platforms, as this is the only way they will act to prevent it.

But most of all, I want to see people I can trust in positions of power (as, it seems, do 97% of the population). I want individuals who have empathy and expertise, rather than just those with expensive educations. People who are motivated to do the right thing for others, rather than self-enrichment, and who have enough integrity to stand down if they are seen to have acted with impropriety. I want politicians who spend less time curating their image, and more time attending to the best interests of the population. Where you see the real person, not a persona they have created, and where being willing to work hard is not a costume they are putting on for the day.

At the top of the hill

I have posted in the past about the feeling of running a small entrepreneurial venture, and how it can feel like pushing a giant boulder up a hill without much help, and how every time I think I’ve reached the summit a new peak appears. Well, for the first time, it feels like that feeling has changed. Suddenly it feels like I’m at the top of the hill, and I have a team of people to help me think about how to make the boulder roll. It is still a daunting task to get the thing to roll in the right direction, and there is still no guarantee it will start to gain momentum and size, let alone reach a good destination. But it does feel like possibilities are opening up that weren’t in my line of sight before. In fact, I now have the task of trying to scale up my ambitions – which is a really strange thing, after trying to keep my focus very much in the present and not falling backwards for so long!

So what has actually been going on? Well, in 2019 we secured a local small business grant to allow us to prepare to scale up. That gave us £50,000 to cover half the costs of getting some basic equipment and taking on an operations manager. We replaced some very dated laptops, and got some new desks and cupboards for our offices, only for the start of the pandemic to lead us to need to move to working from home.

That was particularly pressing, because the office we rented shared a stairway with three other units, which had just changed from very low risk, low traffic businesses (a geological survey company and a quantity surveyor) to a domicillary care company with over a hundred staff that were coming and going from the office in and out of elderly and vulnerable people’s homes. As an employer with staff who had various pandemic-related challenges (eg an employee with asthma who had to travel on public transport that included a lot of children on the school run; an employee in a multi-generational household; a vaccine-hesitant employee) and as a person with increased vulnerability myself due to preexisting medical conditions, we were quite proactive in that decision. I closed the office the week before the government officially locked down, and made the decision four months later to give up renting the office and go to a fully home-based working pattern until the pandemic risks resolved. Whilst that was a big adjustment, and I miss physically getting together with my team, having that social element and bouncing ideas off each other, in a lot of ways it has worked to our advantage. I’ve personally appreciated not having to travel as much, and reducing my carbon footprint, and it has allowed us to deliver projects all over the UK as everyone has become familiar with working remotely over Zoom.

We then secured a £220,000 Innovate Smart Grant to work with local authorities and complete our data set for BERRI. That allowed us to recruit a research team in the Anna Freud National Centre for Children and Families/UCL, where I also have my Senior Research Fellowships, to help us make sense of the data we collect and publish the validation, factor structure and early findings from BERRI. We have then set up partnership projects with eight local authorities (six in London and two in the north east). We added an Operations Manager and two Assistant Psychologist/Fieldworkers to our team to deliver the project. Working remotely meant we could also provide some light-touch input to placement providers across the UK, so we’ve continued to grow the number of organisations with BERRI subscriptions, and our ability to deliver training and consultancy online. We then secured a £96,000 Resilience grant to mitigate some pandemic related delays in the project, add some clinical staffing, commission an independent social and economic impact evaluation of our work, and use some sessional input from psychology graduates for a project in which we plan to build a wider “ecosystem” of resources around BERRI. Coupled with using the government Kickstart scheme (which subsidised businesses taking on young employees who were claiming Universal Credit) to take on three new members of staff, our team has grown rapidly. We now have input from two other qualified clinical psychologists, a small in-house data analytics team, a post to look at identifying and securing further grant opportunities, and a digital training administrator.

There have been other positive side-effects of the move to remote working. We’ve been able to recruit from a national pool of applicants and become more disability friendly – so our team now includes members from Kent, Cardiff, Somerset, Bradford, London, Buckinghamshire, Birmingham, Essex, Suffolk, Liverpool and the north east, rather than just local colleagues around Derbyshire. So I think we will probably work towards a hybrid model in which we have a small office space we use for meetings and training events, that local staff can choose to use when they want to spend more time with colleagues, which should be ready by the time the latest Omicron wave subsides. As well as continued court expert witness work, training and consultancy, and two new projects with additional local authorities, on the clinical side we are also setting up a second base in north Birmingham, where we plan to run a small neurodevelopmental assessment service. So we have recruited another AP to support that location, bringing our team up from me plus six employees in 2019 to me plus 19 today. We also have a network of placement students, researchers, contractors and sessional workers that mean we have over 40 colleagues in our wider network.

That’s a huge shift, and the rapid growth looks set to continue. We’ve secured two more small grants to develop a digital training platform and a demonstration app version of BERRI, and we’ve just submitted a large grant application to build on our work with with local authorities. The independent social and economic impact evaluation has generated some amazing stories of how BERRI has changed the way that services are able to deliver psychological support to young people in care, and their lives have been positively impacted as a result. Whether it is a young person who was stuck in an inpatient secure bed with a negative prognosis who is now living in the community with aspirations of employment, a carer who is able to be more empathic to a child’s trauma history rather than seeing them as naughty, or a professional who feels more able to do their job effectively, it is amazing and rewarding to hear that my little project to develop an outcome measure for children in care is helping to create these increasing ripples of positive impact. It has also shown a remarkable level of economic impact, with over £108 return to the economy for every £1 invested in our service! My goal to change children’s social care and to find a better way to identify and support children’s psychological needs is no longer just a wild fantasy, but might be something we can actually achieve.

The other positive side-effect for me personally, is that I’m finally paying myself the salary I would be on in the NHS. After having started the company by investing my redundancy pay, a decade of subsidising the project through my court expert witness work, and some months where I drew down money from my own mortgage to pay staff, that is no small milestone! It means we are secure enough financially to firm up the social purpose embedded in the business into a formal social enterprise structure, where the majority of profits are pledged to delivering the social impact goals (which isn’t a hard task, given the vast majority of our turnover has always been spent on research and delivery of clinical psychology services).

So, what are the next steps? We have lots of new developments in the pipeline. The BERRI system itself is constantly being improved in various ways, so the next steps are adding third party reporting (eg if a social worker wants to get a questionnaire filled in by a foster carer, or a psychologist wants to get the school to complete a BERRI about a child they are assessing), putting percentile ranks into the reports for greater granularity, and improving our reporting of data to organisation by adding a dashboard with new data visualisations. We are exploring the potential of a Personal Edition of BERRI for concerned parents to fill in to know how best to support their child. And we are building an “ecosystem” of information sheets and videos to advise parents and carers about common issues.

We have several current research studies:

  1. Meryl, our PhD student, is collecting the community norms for BERRI. So if you are a parent of an adolescent in the UK, or know anyone that is, please use this link: https://uclpsych.eu.qualtrics.com/jfe/form/SV_9um9UfYGd2HX9gW (ethics granted by UCL). We really want as many participants as possible, and you don’t need to be concerned about your child or have any involvement with social care – we just want to hear from as many parents as possible (and if your child has no difficulties it should only take 5-10 minutes to compete). If you don’t have kids yourself, please share the link with others, and post the link to our research facebook page on your social media: https://www.facebook.com/BERRIResearch/
  2. If you live outside of the UK or your child is not aged 11-18 to qualify via the UCL research link, and you want a link to the questionnaire to rate a child or young person aged 5-21, just email earlyaccess@BERRI.org.uk, as I can offer free early access to the system to anyone willing to give us some feedback about your experience.
  3. We wanted a few people to complete a BERRI about their child (of any age) and then to complete a short interview about their experience, an MSc student at NTU undertook this as a research project. Another MSc student on the same course interviewed foster carers about how different life experiences impacted upon children in their care.
  4. We are also going to look at how we incorporate the young person’s voice into BERRI, and recognise signs of progress, strengths and post-traumatic growth.

I’m going to apply for some larger grants to look at scaling up our impact, and we are busy expanding the clinical side of our services to deliver more assessments and consultancy. BERRI has been used to review the use of residential care in some authorities, and to idenfity when children are able to return to family based care (either a foster placement, or to a member of their birth family) and what support is required to make this successful. This has generated significant cost savings for some authorities, so we have been commissioned to provide a similar review for a new authority. We are also supporting the growth of in-house residential provision in a couple of authorities, and expanding our clinical services to support fostering and edge of care consultancy in others.

So the future seems full of opportunity to make impact and – provided I can keep up with demand and keep all the plates spinning – maybe that boulder I’ve been pushing up the hill will start to roll. I just need to work out where we want it to get to!

What a bloody mess!

This post is about periods. It is personal and somewhat more visceral than the things I usually write, so if you don’t like descriptions of blood and gynaecological issues, you might want to skip it. It does feel a bit uncomfortable to share something that feels quite private, so I have waited a while to click post. But I want the information to be out there for other people to find, and to encourage research about the impacts of hormonal contraceptives on women’s wellbeing, so I wanted to share my personal experience. And I figured that I wanted to support other people who have spoken out, like Caitlin Moran and Naga Munchetty.

I’ve never had easy periods. Since being a teenager I’ve had marked PMS the day before, with aching belly and back, tearfulness, labile mood, moments of anxiety and irritability, as well as an increased risk of migraine. Over the decade since having children (which my Mum had always told me was the end of her period pains) they got worse. I would often experiencing clusters of sharp “spike” pains as my period approached, which seemed as if they sent needles from womb to bowel and could double me over in pain, and make it impossible to get comfortable, but were thankfully intermittent and would rarely stick around for more than a few hours. During the actual period days I would get disconcerting numbness in my upper legs, as well as abdominal pains which were almost disabling on the first day of my period, and would often transmit through my lower back. They were also associated with changes to my energy level, appetite and mood. Doctors didn’t seem to think this was a medical issue, and the only medication I tried led to cramps so severe I was curled foetal on the floor for an hour, so I never took a second dose. By trial and error I learnt that heat around my midriff seems to help, so at times I would need to retreat to bed, or my last resort of sitting in a hot bath for hours on end. When it comes to medication Ibuprofen helps the most, but I often need to combine it with prescription strength co-codamol to manage the first day.

I never really thought about how my periods compared to other women, or whether my experience was normal or a condition like dysmenorrhea or menorrhagia. I guess I just accepted that I would always have period pains, and tried to schedule my life so I didn’t put anything important on the day my period was due or anything that might need a level head the day beforehand. I’d been brought up that periods were something private, that you didn’t talk about with others, so I generally tried not to complain about it. This was reinforced by a head of year that would make me run around the school field if I asked to be excused from class in secondary school when my legs went numb and the level of discomfort prohibited me from being able to sit in the classroom. She said exercise was good for period pains, which may be true, but I suspect she just wanted the overweight girl to stop complaining and get extra exercise.

After having twins I had heavier periods with more marked blood clots, so I joked to my husband about bleeding for two. I become anaemic a few times, perhaps because I’m vegetarian and my iron stores were depleted by the twin pregnancy and never fully restored. I don’t know for sure, but I was told to take vitamins with iron every day, and have done so reliably for several years now. On the good side my periods were always as predictable as clockwork, and using a menstrual cup has helped a lot with the discomfort and length of my periods, as well as reducing the risk of embarrassing leaks (and being more ecologically sound). As a result the pain rarely lasts after the first day or two, and the period itself is short and usually tails off after three days. That gives me 24 good days per month, and only two days that seriously interfere with my functioning. I can normally manage to do some work even on the worst days if I take painkillers and wear soft warm clothing around my abdomen, but my functioning is definitely reduced and given the choice a warm bath, or a duvet day is better.

However, in 2017 I mentioned my heavy periods and the fact I get marked period pain to my GP, who suggested I try a hormonal IUD, telling me these much reduce bleeding and stop it altogether for a large proportion of women. I had previously tried the Mirena in 2002, long before having children, but had found it uncomfortable and asked for it to be removed after a few weeks. However this time the GP said it would be much more comfortable since I had carried twins and delivered them naturally (albeit prematurely) so I agreed to give it another go. After a ridiculous delay of nearly a year to find an appointment when it could be fitted at my GP practice, I found a sexual health clinic and booked an appointment during June 2018. My GP had prescribed a Mirena and a Jaydess, and I had collected both and took them to be fitted. There was no mention of potential side-effects in any of the conversations I had with the GP or the clinic where it was fitted, although I was told to take a painkiller just before it was fitted, as they said “for some people it isn’t a comfortable process”. I think I had also read that there might be some cramps whilst my body adjusted to it.

The first problem was the fitting. It hurt. Enough to make me considerably uncomfortable. It was a right-to-the-nerves-at-the-core-of-my-being-do-not-pass-go pain that was different to ordinary pain, of which I’m normally pretty tolerant. The nurse and care assistant tried to make conversation to distract me, but the pain meant I kept losing concentration and wasn’t really able to talk properly, and I felt like I was going to faint at several points. It hurt being dilated. It hurt being measured. It hurt when the nurse tried to fit the Mirena and removed it when it didn’t fit correctly, and then it hurt when he inserted the Jaydess. He said my cervix spasmed, and that the whole area is very near the vasovagal nerve and can be very sensitive. But once he had finished and removed the speculum I had high hopes that I’d done the hardest part. As I drove home the painkillers kicked in and the pain settled to much like the level of period pains.

However, that period pain feeling stuck around in variable intensity for much of the time I had the Jaydess in, which ended up being nearly four months. I also had aches and spike pains throughout the month, to the point I needed painkillers on more days than not. There were times it felt painful to stand, or that I couldn’t sleep for the pain. I got hot flushes. My boobs ached for three weeks out of every four, to the point they were tender to the touch and hurt if I took my bra off. There was severe bloating and intermittent nausea, and a feeling like having a perpetual bug of some kind. I had loose bowels and painful stomach cramps after eating that meant I couldn’t enjoy food. I had lots of headaches, and a kind of aching in my bones and joints (particularly my hip joints) that made me feel old and unwell. My hair became really greasy, to the point it was visible by the end of the day, and looked awful on day two, when previously it was fine for two or three days and I never had to think about it between the times I went swimming. I got painful cystic acne on my face, shoulders, back and bum. Not in huge numbers, but there was always a new zit or two visible in the mirror each day, they took several days to rise to the surface of my skin, and it increasingly felt uncomfortable (when prior to the IUD I’d only get a couple of visible spots per month, and they were never painful).

It also changed my mood. Like the worst examples of how I had been on the day before my period before, I found myself on the verge of tears about anything sentimental or sad, and my feelings felt less rational and less within my control. I had patches of acute anxiety, and generally lower mood, with greater irritability. That may have been compounded by the fact I had weird dreams and disrupted sleep, and would often wake in the night with stomach pains, cramps or aching and find it hard to get back to sleep. And to cap it all my periods were longer and heavier than before, with a shorter gap in between, leaving me only one week of feeling relatively good, and even that was characterised with lots of low level aches and pains. A minor additional problem was I couldn’t reach the coil’s strings to check it. I don’t know if that is my short fingers or inflexibility, my slightly retroverted cervix, or whether they were clipped a bit short. But it was a bit unnerving to be told to check it and not to be able to.

Weirdly, I was prepared to tolerate all that for month after month on the basis that it might get better over time and reach a point where the side effects disappeared and the promised effects appeared. They had told me to stick with it, and that things would get better, and I was determined to do so. But the symptoms seemed to get worse month by month, rather than reduce or resolve. The final straw was that my vision started to blur. I noticed that I couldn’t see the TV properly from the sofa, and was moving forwards to sit on the floor closer to the screen. I couldn’t see the road signs or number plates when driving until much closer to them than usual. And anything at a distance seemed fuzzy and indistinct. That made no sense, given I’d just had an eye test that said my vision was fine only a couple of weeks before I got the IUD. In fact, my prescription had not changed for over a decade, and I’d been wearing the same contact lenses and glasses for as long as I could remember. My eyes started to feel dry in the evening, and my contact lenses also started to feel uncomfortable, after being almost unaware of wearing them for most of the last thirty years. I read online that levonorgestrel can affect your eyes. So I went back to the optician. He said there was nothing overt wrong that he could measure, except that my astigmatism, which had previously been below the level at which they correct it, had markedly increased and I now needed toric lenses to compensate for this. He didn’t think it was related to the Jaydess, but the sudden change seemed very strange.

Looking up the side effects of Jaydess/Mirena made me realise quite how many I was experiencing, and how this wasn’t typical of the official reported level of side effects, or the miraculously lighter and easier periods I had been promised. So I phoned the GP, who tried to get me to persist, promising it would settle, and really didn’t seem to listen to or appreciate the level of discomfort it was causing. After nearly four months I insisted it was removed. That actually went pretty smoothly. I managed to get an appointment with the one female GP with an interest in contraception. She listened and said it didn’t seem to suit me and agreed to remove it on the spot as I had not had unprotected sex in the prior seven days (to be honest, it had been a pretty effective contraceptive in that it put me off sex altogether for the entire time that sharp anchor of metal was inside me). The removal was equivalent to having a smear test. The awkwardness and discomfort of the speculum, then one second of that direct-to-the-vagus-nerve pain and it was done. Afterwards mild aching that was relieved by analgesics. So I figured it had gone pretty well. Again, there was no warning from the GP or in anything I was given to read of any symptoms likely to appear because of the artificial hormones disappearing from my body.

However, that mild aching came and went for the next few days, and then I started to get cramps and traces of dark brown blood as my period approached. That developed into a fairly typical PMS level of discomfort, but the volume of blood was still very small and much darker than usual. Typically my periods arrive quite quickly after the PMS and cramps, with two days of moderately heavy flow (about 40-60ml per 24 hours) and the bleeding then tapers off during the third day (making a total volume of about 80-120ml shed during the whole period). Hence the use of a femmecup, which can normally see me through the night, or through a working day, without any problems. However this time around my period started slowly, but then on day three there was suddenly large volumes of thin bright red liquid blood like the stuff they squirt around for a horror b-movie. At times it filled the 30ml of my menstrual cup in under an hour and if I didn’t catch it, this unusually liquid blood then leaked out onto my clothing or bedding spreading obvious bright red stains. No form of sanitary protection helped. I had more leaks and mess in that two days than in the last decade of periods combined, and had to change enough clothing and launder enough bedding to run the washing machine twice (both times having to interrupt it to add more items after the wash cycle had started). I’d estimate I bled 250ml of this thin bright red blood over 48 hours – that’s seven times the volume of an average woman’s period, and more than double my usual total in a very short period of time. It was incapacitating because of the need to empty the cup so often and the risk of embarrassing leaks, but it didn’t hurt at all. I just felt a little nauseous and faint, which might just have been a reaction to seeing so much blood. And no matter how careful I was it kept creating crime scenes for a low budget horror movie.

It would have utterly freaked me out, and perhaps even sent me running to A&E, except that I found other reports of similar bleeding after the removal of Mirena on the internet. Thankfully after the second day of flooding it petered out. I’d guess I bled near 300ml in total, which is ten times a typical period and nearly the amount I donate from my veins when I give blood as a donor. I really think they should warn women about that, as that much blood without warning has the potential to be pretty traumatic.

By then I had read about the “Mirena crash” and was prepared for massive emotional symptoms that might spiral me into a depression, but thankfully they were not too bad compared to what others report – perhaps because (like any review site) it is only the more extreme experiences that motivate people to write about them, or perhaps I’m normalised to some hormonal symptoms, or because the Jaydess uses lower doses of hormone, or because it had only been in for three months. I did have increased emotional lability, to an extent that was very out of character for me and created a couple of protracted emotional confrontations with family members about minor things I would normally have let pass without comment. Plus for a week or two I was in a generally more negative headspace. Possibly the most disconcerting element was patches of free-floating anxiety; I’d get a sudden sense of having remembered something I should have done, or had done really badly, or that had made someone else react really negatively to me, or foreboding about something terrible happening, but without anything to pin it to. And then, gradually, it settled back down to more or less how things had been before. The breast ache, abdominal pain and cystic acne dispersed and I went back to the prior level of period pain I had been having for the decades before.

About 18 months ago I finally saw an endocrinologist who tested lots of things and didn’t find anything he needed to treat, but referred me on to a gynecologist. Whilst I hadn’t had symptoms I’d associate with menopause, like hot flushes or cessation of periods, loss of libido or vaginal dryness, she seemed particularly swayed by the fact I was 45, had missed one period (albeit with timing that seemed related to other stress/health issues) and had experienced anxiety, minor memory issues, and joint stiffness (though the latter has been present since an RTA in 2015), and concluded the underlying cause of all my symptoms was probably perimenopause. She recommended I try HRT – even though most of the symptoms I reported had been the same throughout the prior decade, and many had been fairly consistent since I was about 15 years old. I was cautious, given the one ingredient in the HRT is the same as the hormone used in the coil, but I didn’t have any better options and decided to give it a go.

I went onto HRT just as the nation went into lockdown for the coronavirus pandemic, so it was hard to pick out what was the result of the acute anxiety I felt at that point and what was side effects of starting the meds. Subsequently it has been hard to unpick the impact of the HRT from the impact of pandemic lifestyle changes. When I weigh up the positive and negative changes I have observed, it is a fairly close-run contest, but overall I think it has more benefits than costs, particularly in my mental state. On the good side, I have less marked emotional swings prior to my period, and my anxiety has reduced. My periods are slightly less heavy, and there has been a small reduction in pain. On the down side, my skin is now very dry and I seem much more prone to heat rash in my armpits and groin, and thrush-like discomfort. I’ve also put on some extra (and very much unwanted) weight – but I’ve been much less physically active as I haven’t been swimming or to the gym. Given the risk of stroke, I decided I’d rather be on patches than tablets, but was closed to gynecology and none of the GPs felt able to review my HRT since the female partner left. However, I kept pushing and eventually did get the patches, and they seem to have continued the positive effects whilst they have reduced the heat rash (and risk of stroke). I can also slightly extend the days I use the first type (which don’t have negative effects) and shorten the other type. And I have returned to predictable as clockwork menstrual cycle.

Whilst clearly everyone’s experiences of health conditions and treatments are different (and I’ve known several colleagues who raved about Mirena) there are some wider themes that I think are more universal. I’d say my experience of putting up and shutting up is probably quite typical, in that lots of women just get on with things. We are taught not to moan. Women’s reports of pain are taken less seriously, and conditions like PCOS and endometriosis are massively underserved with unreasonably delayed diagnosis and limited treatment options. Medical research treats men as the default, and sees women as innately skewed by our hormones. The funders setting priorities and the people leading the research are more often male, so they don’t give women’s health issues the same level of priority. Contraception is seen as a problem women must shoulder the burden of, and menopause something shameful we must hide and suffer in silence (Davina McCall’s TV program on this topic captured it well). These issues really aren’t things men would be expected to tolerate. I was really struck by the furore about the few awful cases in which people had blood clots after receiving their covid vaccination, and how the probability was a fraction of that caused by the contraceptive pills millions of women take without the same level of public or professional concern. Women’s health is too often forgotten and devalued. No wonder periods and contraception are so poorly addressed, and so many women suffer in silence. So I’ve broken my silence, and I hope I can encourage you to break yours, because talking about this stuff will show that it exists and impacts millions of people.

Our relationship with alcohol

Today an article from WHO about reducing the harm caused by alcohol around the world has got people all fired up on social media. The article has slightly clumsy wording about prevention of harm to unborn babies from alcohol, that some people have interpreted as a recommendation to prevent women of child bearing age from being allowed to drink. In response people have jumped in as much to defend/normalise drinking as to stick up for women’s rights (and to rightly criticise the way certain other types of risks from alcohol are only mentioned by reference to other documents, such as the risk of interpersonal violence, or not mentioned at all, such as the risk of perpetrating or becoming a victim of sexual assault). Having tried to reply on twitter but ended up with a mega-thread, I thought it might be preferable to respond fully in a blog post about our relationship to alcohol, including some links to relevant psychological theory.

Before I begin, I should note that I’m not an unbiased observer on this topic. For the last 30 years or so, I have chosen to drink very little alcohol (typically about 5 units per year) as I don’t particularly like the taste of most alcoholic drinks, or the way I feel after the effects have worn off. I also had a very negative experience of being drunk early in my life (see this blog entry, which comes with a trigger warning about sexual assault). That led me to often choose to be the driver or the person who stayed sober on nights out, which also gave me a rather atypical perspective on alcohol – as I was often the person who was looking after the person who had puked up or passed out, or was vulnerable to sexual assault. Speaking of which, I have previously expressed some strong opinions about whether alcohol is an excuse for behaviour (it isn’t; blog also deals with sexual assualt).

So, I am fully on board with the criticism that any global policy about alcohol needs to mention its association with interpersonal violence and sexual assault. We know that drugs and alcohol are often the source of disinhibition for abusers (and can be a step used in overcoming inhibitions for those who feel guilt or social pressure, such as in Finkelhor’s model of factors neceesary for child sexual abuse to occur). We also know that they are often used to create vulnerability in victims (eg with use of drugs in alcoholic drinks by rapists like John Warboys and Reynhard Sinaga) and that the vulnerability of intoxication is frequently exploited as an opportunity for sexual assault. As BPAS say in their response to the document “In the UK alone, more than a third of sexual assaults, more than 39% of all violent crimes, and nearly 1 in 5 incidents of domestic abuse are committed under the influence of alcohol” and this clearly needs to be mentioned in a document about reducing the harm caused by alcohol around the world, more than by passing references to other WHO documents about violence.

However, I’m also someone that believes in preventative and health promotion interventions like schemes to provide healthy food for pregnant women and young children, or the tax on sugary drinks. So it should come as no surprise that I’m broadly in support of measures to reduce problem/excessive drinking and tackle the culture of binge drinking amongst young people. I think a minimum price per unit of alcohol, and more education about alcohol (and drugs) and their risks and benefits would be a good starting point. This should ideally be part of the national curriculum for children, and something that is revisited at developmentally appropriate levels.

So, with my general opinions laid out, let us return to today’s publication. The WHO document is called “Global alcohol action plan 2022-2030 to strengthen implementation of the Global Strategy to Reduce the Harmful Use of Alcohol” and is clearly marked as a first draft. The statement that has been perceived as controversial is that they recommend we “raise awareness among decision-makers and the general public about the risks and harms associated with alcohol consumption. Appropriate attention should be given to… prevention of drinking among pregnant women and women of childbearing age”.

To state something I hope would be obvious: Taking a literal interpretation of this sentence to mean that all women of fertile age should be prevented from drinking alcohol would be ridiculous and awful. I strongly agree with the critics that women are more than just breeding vessels, and that it would be massively disproportionate and set back women’s rights to prevent all women of fertile age from drinking on the basis of potential harm to a foetus. There are many complex and interwoven issues here, the way that gender and fertility have been conflated ignores the presence of anyone trans, intersex or with any of numerous medical conditions that can create infertility. It also assumes that all women are sexually active and none are using contraception or taking any control over their ability to conceive. Taken literally this therefore extends guidance that is perfectly logical for sexually active women who are fertile and not using contraception to every person identifying as female under the age of 50. However, I hope is a thoughtless omission in their wording rather than the intended meaning. It also assumes that any consumption of alcohol at any stage of the pregnancy is potentially harmful to a foetus, which does not appear to be entirely supported by science (where to the best of my current knowledge it would appear that low consumptions of alcohol have not been associated with harm and there are particular windows during pregnancy in which harm to the developing foetus is more or less likely to occur). Thus advice to avoid excessive or chronic consumption of alcohol during pregnancy appears to have been extrapolated into advice for all women of fertile age to consume no alcohol at all. And that clearly needs to be clarified as this first draft is developed into the final published document.

However, I genuinely don’t think that is the intended meaning here. The document doesn’t mention the rights of the foetus being more important than those of the mother as some critics have inferred (in fact it doesn’t even use the word foetus). Nor does it call for bans on the sale of alcohol to women (in fact it doesn’t even expand on the topic of female alcohol use at all). It only uses the word “women” four times, twice in that sentence, once in relation to mortality and once when talking about the incidence of alcohol use disorders. It literally just says the one sentence I quoted above.

I can see that the wording of the relevant sentence is slightly clumsy, perhaps because of international authors, but It is my belief having read the full guidance that this document is not advocating an unreasonable curtailment of the freedoms of women. Whilst it mentions “prevention” of women drinking, this is in a section entitled “Advocacy, awareness and commitment”. It is written in the context of preventing harm by reducing the social pressures encouraging excessive drinking and providing information about risks that would lead to informational campaigns discouraging children and pregnant women from drinking. It is not an assault on feminism or suggesting that states increase authoritarianism.

And importantly, this isn’t a personal message to individual female readers. It isn’t some jumped up know-it-all judging you for having glass of wine or two in the evening to unwind. It is a draft policy statement proposing educating people around the world about the risks of drinking whilst pregnant in the hope that more women choose to abstain. If you are past menopause, or not sexually active, or use contraception, or drink little/no alcohol, or for any of a myriad of other reasons aren’t going to end up binge drinking before realising you are pregnant, this message to reduce or cease alcohol consumption is not for you. You can let go the anticipated reproach and stand down.

Whilst the tabloids are trying to make this into a big deal, this fits with their xenophobic British exceptionalism agenda, whereby they are dismissive of international bodies, experts and science and try to frame them as limiting personal freedom and autonomy. So when they use stories like this to fuel the “nanny state curtails our rights, its political correctness gone mad” narrative, remember that each of these little fires is built to distract from the way the government are slowly attacking our rights and the safeguards over their power like the right to call for judicial review of government actions, GDPR and the protection of our data from commercial exploitation. Like the fantasy that conservative voices are being cancelled/silenced by an oversensitive generation of woke snowflakes rather than that market forces mean racists and sexists are increasingly feeling the rightful consequences of their repugnant views, or the way that taking the knee to acknowledge racism exists and needs to be tackled has become some unpatriotic politicising of football, this is just a distraction technique. These stories distract from the unlawful crony contracts that have funnelled public funds to friends of cabinet members, the way politicians no longer resign when they are found to have been dishonest, the failure of Brexit, growing inequality, the mess they have made of the pandemic and all the other ways the Overton window has shifted right and the current pack of corrupt incompetents are making a mess of governing the nation.

I think the best way to look objectively at the issue here is to let go of the wording and look at the overall tone of the message. WHO advisors are trying to reduce rates of death, disability and children harmed by foetal alcohol exposure. Surely that is a good thing? It is directly parallel to trying to prevent cancers/disease and harm to others from smoking (including during pregnancy or around young children) – something that was socially acceptable until surprisingly recently. Smoking is (or at least was) another choice that some people find enjoyable, but scientific studies associated with excess mortality. If we saw a publication warning women about smoking harming an unborn child it would probably not immediately make people want to post “oh just reading this makes me want to smoke a whole box of cigarettes”. So I wonder, objectively, why a twitter post replying to the report saying “I’m not sure where to start with this. Maybe by opening a bottle of wine?” has received so many likes?

For context: Alcohol causes 3 million premature deaths a year – that is more than tuberculosis, HIV/AIDS and diabetes. This includes 13.5% of all deaths among 20 to 39-year-olds in the world. In Russia and eastern Europe, nearly a third of people’s lives are shortened by alcohol use, though the rate in the UK is about 3.4%. In the USA research shows that alcohol contributes to about 18.5 percent of emergency room visits and 22.1 percent of overdose deaths related to prescription opioids. Around the world about 1.4% of people are considered to have an alcohol use disorder, with the highest prevalence in Russia and neighbouring states, where it is about 5%, and Brazil and Greenland, where it is about 3%. In America the diagnostic rate is higher (at about 5%), but it is unclear whether the prevalence is higher or the thresholds for diagnosis are lower. Globally, alcohol use disorders lead to 185,000 deaths per year, with around 2300 in the UK. This number has increased considerably since the 1990s, but has been fairly steady for the past 15 years. Few of these people receive formal treatment, with only 5-6% getting treatment in the UK. The incidence of alcohol use disorders increases significantly for those with mental health problems, showing that either the same stressors can lead to both outcomes, or that mental health problems can increase the risk of alcoholism or vice versa.

Problematic alcohol use can either take the form of binge drinking – where the drinking is excessive in quantity, but happens intermittently, perhaps once or twice a week, or on particular occasions or where the individual gets together with a particular social group – or chronic and excessive consumption (where the individual drinks every or almost every day over a protracted period of time). Both patterns are surprisingly common.

About 25% of the population meet the criteria for binge drinking on surveys about alcohol consumption, whilst around 7% report heavy drinking (5 or more units per day on 5 or more days during the last month). Even within geographic regions, there is a high level of variation between countries: in Italy, only 6 percent of drinkers had a heavy episode of drinking during the past month in contrast to nearly half in Ireland; 42 percent in Belgium one-third in the UK and France; and 20 percent in Spain. Binge drinking is particularly common amongst students and young adults, with around 50% of those who have ever drunk alcohol reporting in surveys they had drunk to the point of blacking out at least once, and 10% reporting a blackout associated with drinking in the prior two weeks. If some of those young women are becoming pregnant (perhaps due to sexual encounters when intoxicated), that level of drinking could potentially be a significant risk factor for the unborn babies.

Drinking alcohol to excess can also lead to other additional risks for the drinker. Whilst the immediate effects of alcohol are usually perceived as pleasant, and resolve fairly quickly when drinking stops, they can lead to memory lapses, poor judgements and an increased risk of accident and injury (as well an increased risk of sexual assault). Blackouts can involve potentially dangerous behaviour and loss of consciousness. Binge drinking is known to increase the risk of medical crises, and is a significant contributor to the number of people who present at A&E. Studies show that compared with people who did not binge drink, people who drank alcohol at twice the recommended thresholds were 70 times more likely to have an alcohol-related A&E visit, and those who drank three times as much as the recommended limit were 93 times more likely to present there.

Alcohol also presents other less acute risks of harm. The effects of alcohol on the body become more severe with larger volumes consumed over extended periods of time – with particular risk to the liver, heart and brain. Changes to the brain can eventually disrupt memory and lead to Korsakoff’s syndrome. Alcohol is also physically addictive, with greater risks associated with sudden withdrawal than most drugs.

There are no hard and fast rules, but chronic excessive use appears to follow a different pattern to binge drinking, which is typically social – perhaps because the cost of alcohol in quantity soon prohibits this being consumed at pubs and clubs, or because of the pattern of drinking, or the impact of the level of intoxication on social functioning. The reality of problem drinking is, like most things in life, a bit more complicated than simply being the upper section of a spectrum of consumption. It seems to have some biological components, marked social components (eg when alcohol is used to cope with social situations or fit with peers) and is often cumulative over time. As with most addictions serious alcohol issues are often rooted in combinations of learnt behaviour and exposure to trauma. Impoverished or abusive relationships in childhood set a harmful template that can lead to dysfunctional coping strategies and relationships later on. These can create patterns that reinforce problem drinking, and masking the drinking can disrupt supportive relationships.

However, it is not just in the context of alcohol misuse disorders that alcohol causes harm and excess mortality. Alcohol also increases mortality via road traffic accidents. In South Africa and Papua New Guinea more than half of all traffic deaths are attributable to alcohol consumption. In the US, Canada, Australia, New Zealand, Argentina, and many European countries alcohol is responsible for around a third of all traffic deaths. Alcohol is also implicated in more than half of all crimes in the UK – either because the crime involves alcohol (eg drink driving, drunk and disorderly, theft of alcohol) or because the person committing the crime had consumed alcohol (eg in violent crime, assault or criminal damage). This is higher than elsewhere in the world where this has been studied.

Alcohol also causes Foetal Alcohol conditions that can have a lifelong impact on the brain. NICE say the exact incidence is unknown, but it was thought that about 7.7 people per 1,000 worldwide are affected, and 32.4 per 1,000 population in the UK. A study following up a cohort of births looking at possible symptoms suggested the prevalence could be as much as 6 to 17% of the population. The official UK advice is that the safest approach for women who are pregnant is not to drink alcohol to minimise risks to a baby. However, multiple sources suggest that 41% of pregnant women in the UK consume alcohol, and research shows women are not universally given information about the risks of alcohol during pregnancy (with 30% of those who drank before pregnancy reporting getting no information on this topic from maternity services, and only 29% of midwives saying they routinely share this information). The messages about how much alcohol is safe are unclear. There is a consensus from the stakeholders that NICE consulted that education and raising awareness of the risks of drinking alcohol in pregnancy is necessary, and 91% of alcohol bottles sold in the UK now warn against drinking during pregnancy. So it should be no surprise that the WHO also feel that women around the world who are pregnant or who may become pregnant (because they are of fertile age and are having sex without contraception) need to be aware of the risk posed to a baby by excessive alcohol consumption. Reducing alcohol consumption in these groups will reduce harm.

Yet as soon as reduced consumption of alcohol is mentioned, it brings out an almost reflexive response. I think some of that is “anticipated reproach” – the defensive (but often antagonistic) response people have to anyone they feel may judge them negatively, which can sometimes be combined with “do-gooder derogation” the feeling that anyone taking the higher moral ground about an issue personally, or taking action to resolve it, must be pompous and judgemental. Anticipated reproach has been studied by Benoit Monin, who has shown the effect in relation to everything from vegans to racism. We can see that playing out in the response to this WHO report. People want to speak out for their right to consume alcohol, and don’t perceive it as harmful (except in others with obviously excessive drinking).

The pandemic has also conflated unrestricted access to alcohol with the idea of personal freedom and agency. Closing pubs has been seen as more of an imposition on our rights than closing schools – particularly for the vocal anti-mask/anti-vax brigade (I wonder if there is some overlap between views about pub-drinking and a rejection of broader progressive values? It certainly seems to be associated with covid denial, Brexit-voting, and dismissal of expert advice, which I associate with a kind of disenchanted malaise that comes from underachievement and a feeling of being cheated by the changing social contract that makes people vulnerable to alt-right propaganda).

But I think this positive and normalising view of alcohol long predates the more recent changes to the socio-political environment, and the increasing polarisation of society. Alcohol has been embedded in our culture for thousands of years, and it holds an important role in social engagement and special occasions. So for most people it has positive associations. It is also an example of something where many people use the substance, yet comparatively few are harmed by it (the same could be said of illegal drugs like cannabis). So (as with the “just say no” campaigns that portrayed illegal drugs in entirely negative terms) dramatic warnings about potential harms don’t tend to chime with personal experience, which may be another reason for the defensive response.

The annual global average alcohol consumption is equivalent to 6.4 litres of 100% proof alcohol per adult per year. This is equivalent to 53 bottles of wine or 225 pints of beer (a bottle of wine or 4.5 pints of beer per week). In the Middle East and north Africa (which contain many Muslim nations where alcohol is frequently prohibited for religious reasons), consumption is much lower than average and often close to zero. In eastern Europe (and Nigeria) consumption is typically double the global average, and western Europe is not far behind. The UK, Russia and Australia are also well above the global average. However the type of alcohol, age and gender of drinkers, and the patterns of consumption vary from place to place. Broadly beer is quite widely consumed outside of the middle east, wine is most popular in Europe, Australia and southern South American nations, whilst spirits are most popular in Asia and Russia. In the UK the consumption of wine has increased steadily over the past three decades, whilst consumption of beer has reduced. The highest percentage of income is spent on alcohol in Europe and Australia – with Ireland being an outlier where around 7% of income is spent on alcohol. In general wealthier individuals drink more, although there is not a higher incidence of problem drinking.

For most people alcohol is a pleasurable mild intoxicant. And most people consume alcohol in moderation, where the impacts on health are more debatable (and in some cases even suggested to be positive – especially when it comes to wine as a component of a Mediterranean diet). So we do have to set the concerns about harm in context with the fact that many people derive pleasure and little or no harm from their alcohol consumption.

However, even when it comes to foods, consumers are increasingly given a warning of the fat, salt and sugar content, so that they can make informed decisions about their health. This balancing of benefits and risks is also something we are familiar with when it comes to the leaflets enclosed with prescribed medications, and has been in the spotlight in relation to the coronavirus vaccinations – where potential harms, like the tiny proportion of people who have had blot clot related complications, have dominated the discourse, despite the fact that for the vast majority of people it is protective and side effects are relatively trivial. Perhaps it is a good precedent that the benefits and risks of something have to be clearly explained even when there is widespread consumption?

After all, alcohol gets lots of positive messages to the public every day. There are numerous adverts showing beautiful, healthy, happy people engaging in social drinking. But on top of this, alcohol gets advertised from peer to peer. I see lots of social media posts about drinking, and almost all have a positive or light-hearted tone. Research corroborates this – surveys of social media show that posts which picture or talk about alcohol use show happy social occasions, groups of people interacting, romantic settings and chilled nights in. They talk about fun and exciting experiences, celebrating, dancing, dating. Posts rarely show risks or consequences. There are numerous memes like “wine o’clock” or “just a little glass” with a picture of an enormous glass of wine, as well as many references to alcohol as a survival strategy or a means to cope with parenting. Comedians joke about binge drinking and Irish weddings. I’m not sure people think about the impact before sharing posts or memes that feature alcohol, but studies show that exposure to alcohol posts on social media leads to increased alcohol consumption (why else would alcohol companies spend billions on advertising?). This means that seemingly harmless posts can potentially have negative impacts on others. This might particularly be an issue for those who have a problematic relationship with alcohol. Studies have also shown that people who post about alcohol consume more of it.

Yet it seems we each normalise our own consumption. Alcohol consumption and related risk is influenced by how the person perceives they compare to others in the population (if they believe others drink as much/more than they do, they believe their drinking is less risky). This is compounded by overestimating norms. So the more we drink, the more we assume others drink to subconsciously justify our own drinking (the same pattern also appears to be true of drug use, or sexual behaviours). The influence of social norms is a whole field of psychological research.

But I think that this can also happen at the societal as well as the interpersonal level. There has long been a tendency to encourage/normalise drinking in the UK that leads to people not recognising excessive/harmful use. Perception of alcohol use varies by drink, context, time and characteristics of the drinker. Adults typically regard themselves as moderate drinkers and disapprove of excessive drinking by others. We are not very good at judging the threshold at which alcohol use can be harmful, particularly when we are amongst others who consume alcohol in large quantities. I’ve met many who normalise drinking vast amounts (eg >40 units in a day). So maybe, like smoking and sugar consumption, and our lack of physical activity and increasing obesity, we do need to think more about harm minimisation?

Alcohol causes 24,000 deaths and over 1.1m hospital admissions each year in England, at a cost of £3.5bn to the NHS. Yet at the moment, the only labelling of alcohol to indicate risks is voluntary, as is the industry funded Drink Aware campaign (which sprung from the Campaign for Smarter Drinking instigated by my business mentor and NED Richard Evans before he left the drinks industry). Like the similar Gamble Aware campaign, the aim springs from corporate social responsibility and is intended to maintain profits and consumption whilst reducing harm – which could be considered to be competing interests. Experts say that the drinks industry would lose 38% of their income if drinkers kept to recommended guidelines, losing £13 billion per year of sales, which is why they are so reluctant to promote accurate information about the risks involved. So once again, there is a weighing up of corporate profits against public health. A minimum price per unit of alcohol and increased duty to subsidise costs to the NHS and the impact of alcohol-fuelled crime (eg police, services for sexual assault, refuges for survivors escaping domestic violence) might seem to be appropriate steps towards getting that balance right, but the public really don’t seem to like the idea of raising the cost of their simple pleasures….

Difference as a strength

I read an article recently entitled “There are no black people in Africa“. The idea seems like one of those obvious-once-you-think-about-it things that needs to be said more: People don’t inherently identify by skin colour, we identify by our culture, language, geography, function within a community etc and it is only when colonialism and migration put people in a context where they are seen as “foreign” or “different” that the labels of others (often those with power) group them with everyone else in the world with their skin colour as if this is a simple homogenous group. So in America or Europe there is a notion of “black” (or BME/BAME or BIPOC) being defined by being anything other than the majority “white” skintone, whilst in Africa or the Caribbean (or Asia) people are not defined by that (majority) characteristic, but by things that are more meaningful to them.

I agree with the author of the article that lazy stereotypes then follow from this overly simplistic labelling of others, which allow people to make assumptions about whole races or continents (eg the fictitious belief that all of “sub-Saharan Africa” comprises impoverished tribal communities reliant on western aid, whose lives bear little in common with those in industrialised nations, because all many Europeans know of these nations is the charity appeals during times of war/famine). It also ties into the white saviour thing, where people without relevant knowledge and experience arrogantly believe they can go and solve the “simpler” problems of more “primitive” countries, where their unremarkable skills will bring remarkable insights by comparison to local knowledge.

Even the language exaggerates and simplifies a multitude of difference into two categories; using white and black as polar opposite colour terms for what are actually countless shades and variants of colour from pink to deep brown. Whilst the language then links together people with wildly disparate geography and culture, simply on the basis that similar coloured paint would be used to capture a portrait – which seems a rather weird and arbitrary thing to see as a primary defining characteristic. It reminds me of arranging to meet someone at a conference that I had never met last year, where I described myself as “short, overweight, with long dark hair and a colourful dress” and the person I was meeting said exactly the same description could apply to her. We successfully recognised each other from the description, and we realised we had very similar professional interests also. However, we also realised the one thing neither of us had named was our skin colour – she was black and I was white.

I don’t think the author of the article that triggered this blog has the clearest writing style to convey his point – and he is almost certainly not the first person to name this exact thing. Nor do I think that his insights in the other articles I glanced at are unique or always right (eg other sources don’t support the 7 phrases he says we should stop using because of racist connotations) but I’m glad to have read the article, because it did really clarify some stuff I hadn’t put together myself. The fact I had not, is in the end a mark of privilege; the fact I’m not personally impacted and therefore haven’t had to do the work that so many others have to do day in and day out when thinking about race. I’m lucky to have never experienced racism, despite being a second generation immigrant (nor have I been on the receiving end of antisemitism, despite the fact my Jewish heritage carries its own burden of discrimination). I attribute that to being white and secular in appearance (I’m an atheist by belief).

As an aside: Identifying my own privileged position does make it feel awkward to write about race – there are so many things that I could get wrong, and so many people who are rightly feeling angry or depleted, or who might rather have minority voices amplified than another middle-class white woman add her two pence. All of that is true. But sometimes hearing things from a different perspective also has value, or gives the easily digested intro in familiar language that helps people to access voices with more lived experience. So I hope that if I’ve written anything that rubs anyone the wrong way, you’ll let me know so I can fix it up for others and keep learning.

Recent world events really have higlighted the extent of the problem, and how easy it is to foment division during stressful times – with Trump undermining democracy with his increasingly desperate attempts to cling to power, social media and much of the press amplifying divisive rhetoric and expressing the propaganda of their billionnaire owners, Johnson appealing to the worst elements of nationalism and the pandemic highlighting growing inequality, whilst the national act of self-harm of Brexit is reaching it’s final act. So it is no surprise that racial tensions have bubbled to the surface too, with the again so-obvious-it-shouldn’t-need-to-be-said Black Lives Matter protests gaining traction all over the world. Here in the UK the unequal death toll of covid-19, and the inequality enhancing manouvres of our xenophobic current government have really highlighted how prevalent and dangerous this unspoken level of latent racism in systems and the population really is. It is another stark reminder that what appears like a meritocracy in which everyone has equal opportunity only feels like that to those who are not weighed down by the adversities inherent in the system.

Thinking about the uneven playing field also ties into a phrase I read recently: Talent is evenly distributed, but opportunity is not. As I mentioned in a previous blog, when it comes to investment in business ideas in the UK:

  • only 1% of investment went to all-female teams, whereas 89p of every £1 invested went to all-male teams, and 10p to mixed gender teams
  • black entrepreneurs receive only 1% of funds invested in the UK
  • black female founders received only 0.0006% of the funding invested in the decade from 2009-2019, with only one black female founder in the UK reaching series A investment in that period (compared to 194 white women, and over 4000 going to all male/majority white teams)
  • female and black founders who do gain external investment, secure lower sums of money than their white male counterparts
  • 72% of investment goes to companies based in London
  • 43% of funding goes to founding teams with at least one member who attended Oxford, Cambridge, Harvard or Stanford
  • investors are 91% male, and 93% white, and only 3% of VCs in the UK are black
  • you are 13 times more likely to receive investment with a “warm introduction” from someone in your own network, which reinforces social exclusion
  • 88% of black entrepreneurs self-fund their business without external investment

Yet there are so many challenges that benefit from personal insight that might only come from certain subgroups of the community. I recently read about the founders of CapWay struggling to get investment because the venture capitalists didn’t understand that there are currently people who don’t have a bank account in the USA, for example. Imagine if the founders of Air B&B had never been broke enough to want to stay over on (or rent out) an airbed in a spare room. It gives a glimpse of what might solve a problem those who have had an easier life might never encounter. I’ve met social entrepreneurs who have explained to me the need for a mobile phone in order to identify sources of food or accommodation if you are homeless, or how much female offenders value employment and how this makes them highly dedicated employees. There are also traits that come from surviving adversity that are really helpful in an entrepreneur – being resilient, persistent, being able to juggle multiple demands at once, being grounded in the reality of customers or service users. There are also strong signs that more diverse founders lead to better returns on investment – women founders return more than men, and diverse founding teams more than all white teams. So this is very much an area that is rightly getting more attention.

In my recent business networking with other social entrepreneurs there has been a wide range of people represented in terms of gender, race, country of origin and socioeconomic class. I’ve spoken to people using their links to other countries and cultures in their business, working spanning boundaries, timezones and continents, and bringing ideas to their business from all kinds of prior experiences both personal and professional. I love speaking to people who see things from a different angle, and I am convinced that it so much more helpful to throw ideas around than simply speaking to others who have had similar life experiences to my own. It is one of the reasons I love Impact Hub, as is one of the organisations where all of us in the early stages of developing businesses with a social purpose can find equal support and a culture in which there is value in different perspectives. I’ve used them as my London base for many years, because their co-working space is so convenient for Kings Cross/St Pancras, but they have been brilliant at making an online only membership to adjust to lockdown. And living through a pandemic, I have never been more grateful for my virtual networks to keep me inspired about what I am trying to achieve.

Learn more about the inequalities in business investment here and more about Impact Hub here.

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, and a lot of misinformation on social media. However, 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. First and foremost: Get your vaccination when it is offered. Don’t be put off by scare stories about side effects, as a day or two of aches in your arm or a few hours of flu-like symptoms are a small price to pay to reduce the risks of a deadly disease. Staying safe also means following the latest guidance about lockdowns, masks and social distancing. This applies even after you have had your jab! It is still possible to get covid after you have been immunised, and whilst it is much more likely to be symptomless or very mild, you can still be part of the chain of transmission to others, especially with more contagious variants like the delta strain.

So what do we need to do? The government have put a focus on 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), and remind us to cough or sneeze into a tissue or your elbow rather than onto your hands. There has also been a focus on cleaning surfaces – however the evidence of fomite transmission (droplets on surfaces) has been minimal, whilst the evidence for aerosols (tiny particles exhaled by an infected person that are airborne for several hours and accumulate in enclosed spaces) has become overwhelming. Thus the key prevention strategies are to wear a mask when entering shops or public indoor spaces, and to follow the rules about physical distancing. This means not greeting people with handshakes, hugs or kisses and standing or sitting further away from them than we would previously have done. Minimise your face-to-face social interactions with people outside your household bubble, and try to ensure you only interact with larger groups of people in a safe way – ideally outdoors or in a well-ventilated space. Unless you work in an essential role this means avoiding crowded events and places, not meeting up in large groups, and trying to remain 6 feet away from others, especially anyone outside of your minimum necessary network. Wear a well-fitted 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, so it is really worth preventing contagion if possible. Even if you are not concerned about the impact of covid on yourself, each of us interacts with people who are older or clinically vulnerable – whether that is elderly parents or grandparents, people with chronic or acute medical conditions (eg cancer, heart disease, diabetes, immune disorders, physical or learning disability, obesity, asthma) whether we are aware of them or not. People we know might also be carers for individuals with these clinical vulnerabilities. In fact 3.7 million people in the UK are regarded as clinically extremely vulnerable, and many of them remain very anxious about the risk of catching covid, even if immunised, despite the fact that the official advice to shield has been lifted.

Covid is worth avoiding as even if you are not in a vulnerable group you can pass it on to others, plus – even within the group that are considered to have had only mild symptoms – it makes some people feel like a very bad flu with aches and serious chest pain/breathing problems, and can lead to weeks or even months of tiredness or recurrent symptoms in some people known as “long covid”. However, for many/most people it may not be obvious that you are ill at all, let alone with a serious condition.

If you test positive, or 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 get rested and to self-isolate to prevent spread of the virus. You must also minimise risk of transmission until you have been tested if you have had contact with someone else who has subsequently tested positive for covid, to break the chain of transmission. If you have school aged children you will be asked to complete lateral flow tests twice a week, but be aware these are not as reliable as other tests and can lead to both false positives and false negatives.

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 or if you are interacting with or providing services to someone vulnerable (as well as older age this could include more serious medical conditions like cancer, but also ones that are not normally seen as a big impairment to daily life like asthma, heart disease or obesity, particularly in combination). Ensure you have enough medication, and keep taking preventers if you are asthmatic. If you are in a high risk category and there is a high level of prevalence in your area, then where possible have deliveries dropped off without interpersonal contact. 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, along with good ventilation, careful handwashing and ensuring you avoid physical contact, which can be challenging with a loved one or small child. 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 testing positive if you have had no symptoms, or for 7 days after you stop having symptoms. Where someone is ill but needs care use PPE such as a well fitted mask and disposable gloves, use as much ventilation as possible, and keep washing your hands.

5) Although the government are telling us to act as if covid is no longer a problem, we don’t know if there will be additional waves of new variants of covid, or whether future variants will break through the protection offered by immunisations. Covid is also still causing preventable deaths and lasting health impacts for large numbers of people, as well as causing large numbers of people (including health and care staff) to self-isolate. Combined with the impact of Brexit and chronic underfunding the NHS is creaking at the seams. We need to ensure that the NHS can catch up with the level of need for other conditions, and is ready to cope with an increase in demand if required.

Politicians and NHS managers need to act to grow the capacity of the NHS by addressing the funding and recruitment issues. However, each of us can play our part by reducing our risk of spreading the virus or adding to NHS demands in other ways. This means we should aim to slow the spread of coronavirus (by getting immunised and using sensible precautions) so that the rate of people requiring hospital treatment doesn’t exceed NHS resources, 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 to avoid falls and injuries) and improving your respiratory and cardiovascular health (eg give up smoking, increase exercise, eat healthily, and attempt to lose weight if you are obese).

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. Check in with people who might be isolated and with those who have been bereaved or have had serious ill-health, traumatic experiences, or have lasting symptoms from covid. 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. Trust your own gut about what level of potential exposure to the virus you feel comfortable with, and don’t let anyone make you feel bad if you don’t want to go back to face-to-face work or social events. 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 at the idea of having to do something you don’t feel ready for, 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 – if the anxiety is becoming a problem for you – 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 as often as possible, and leave the window open 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. If covid content makes you anxious but you like connecting over social media, you might wish to use your preferences to tune out posts using terms like “pandemic”, “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 are unable to work or 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 it can be rewarding to see yourself making progress. 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 them 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. If there is a spate of panic-buying (whether of toilet rolls, fuel or fresh produce) 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 delayed/cancelled deliveries to them as they are doing their best. Reach out and make connections to those who might be lonely. 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 due to the pandemic (or Brexit and an inept/corrupt government), 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. New drugs are being developed at a faster pace than ever before, and well-established medicines have been found with positive effects on disease severity/duration. Uptake for immunisations has been good enough to massively reduce mortality. We have tests to show who is contagious. Immunised people (and those who have had covid) are less likely to be a vector for transmission, so rates of infection are likely to fall over time. Air filtration devices are being tailored to removing the aerosols that increase risk of transmission in indoor spaces. Advances are being made all the time.

15) We all know the death rates and current numbers of people infected. The negative stories are spread far and wide, 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. 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 and can genuinely build back better (and not just use this as a vacuous slogan to cover for government inaction).

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 wealthy individuals and 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. Yes, 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 the 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