Blog

Dr Jocelyn Catty is a psychoanalytic psychotherapist and a researcher with a background in English Literature and social psychiatry. She leads the research component of the training in child psychotherapy at the Tavistock Clinic, and is Principal Child and Adolescent Psychotherapist in Bromley Child and Adolescent Mental Health Service in South East London. She is Senior Research Fellow on the Wellcome-funded project,Waiting Times.

In recognition of Mental Health Awareness Week on 10^th-16^th May, we invited Jocelyn Catty to discuss the impact of the pandemic, including the lockdowns, on adolescent mental health in the UK. In this blog, Jocelyn reflects on the Research Article she wrote during the first lockdown and shares her observations from the past year. We also learn more about her own experience as a psychotherapist and the challenges of having to adapt the delivery of mental health services and treatment during the crisis and how patients feel about the changes.

I work as a Child and Adolescent Psychotherapist in a CAMHS (Child and Adolescent Mental Health Service) in South-East London. Until recently, I worked in specialist teams supporting young people who are preoccupied with thoughts of suicide, or who are self-harming.

I first became interested in mental health when I was an undergraduate, when I started acting as a mentor for survivors of child sexual abuse. Later, I worked as a school counsellor for five years, before doing further training at the Tavistock Clinic, and I have also worked with adults for many years.

It is becoming clear that the pandemic is having a range of effects on mental health. For people who have been severely ill with COVID-19, there are concerns about post-traumatic stress and other mental health problems; the effects of lockdown, and of anxiety about contracting the virus, may also be far-reaching. It is really important that we research and understand the full range of impacts.

Adolescents have been in a particularly difficult position. In the UK, three lockdowns have taken them out of school during years that they have been told are crucial for their future education and employment prospects. Adolescence can be a very difficult time anyway: young people are going through so many physical and emotional changes, while under intense academic and social pressure. As is well known, this is usually a time when young people start to invest a great deal of importance in their peer groups, partly as a way of becoming more independent from their families – so to be sent home for such long periods is extremely challenging.

When the UK first went into lockdown in March 2020, my CAMHS had to work out very quickly what we could do over the telephone or online. In my article, I expressed a worry that we were going to have to prioritise “support” over treatment, and of course, in the first lockdown, everyone was very scared, so the emphasis on supporting them was appropriate. We did quite quickly manage to resume treatment by remote methods, however: extremely hard work which has paid off, given that we are still delivering most of our treatment remotely today. We have also had to perform almost constant risk assessments, to help us work out which patients should be seen face-to-face: this is usually those at high risk of hurting themselves.

Delivering psychotherapy online or on the phone is complex. Its success varies depending on the age of the child or their difficulty, but it is also very individual. Some teenagers hate video-calls, while others like them; some younger children participate really well on the screen, showing the therapist toys or drawings as they might in the clinic, while others cannot manage it at all. Work with children with difficulties like autism or learning disabilities has been particularly hard hit, and psychotherapy for young infants, which is often conducted alongside their parent(s), is very challenging over the screen. So, we have been through a process of very rapid and dramatic change, followed by hard work to continue to adapt our methods to the new circumstances.

I originally wrote my paper – which was part of a larger response to the lockdown by inter-disciplinary colleagues on the project (see Waiting and Care in Pandemic Times collection) – during the first few weeks of the first lockdown, when I was myself was very shocked and struggling to work out all the implications of what was happening. And I had no idea that we would still be in this position a year later! On reflection, I think I may have been overly pessimistic about whether high-quality therapeutic work could be delivered remotely: although there are serious pitfalls and it is far from ideal, I think an extraordinary amount of work is taking place in this way.

On the other hand, I may not have been pessimistic enough about the impact of the virus and the successive lockdowns on young people’s mental health. I wrote about how hard this was to assess, particularly in the first wave when emergency presentations actually went down (perhaps because people were afraid to bring their children to hospitals). Referrals have now gone back up again.

For some young people, lockdown has been a challenge they have risen to well, while for others, the pressures of school life can be problematic: for them, lockdown has been an opportunity to collect themselves and recover. Nevertheless, there is now evidence that both emergency and routine referrals have increased (Royal College of Psychiatrists report) – with no increase in our resources. The result is high thresholds, long waiting-lists and over-burdened staff. CAMHS services were already under-resourced before the pandemic, so it seems increasingly clear that we will not be able to manage the increased demand without a rapid and substantial increase in resources.