Social work diary: ‘The boy is struggling and has started soiling himself at school’

A social worker based in a child and adolescent mental health services (CAMHS) team reveals what life is like working on the mental health frontline

A colleague and I get together to start designing a six-week self-esteem group for 13 to 16 year-olds. We have put together some exercises on challenging your negative thoughts as well as tools related to self-care, relaxation and body image.
In the afternoon I attend one of my secondary schools to offer a one-to-one consultation session to a special educational needs co-ordinator (SENCO).

She has been worried about a pupil since the child’s mother passed away last year. The child has become withdrawn in the classroom and often late for school. She is also a young carer for her father who has a number of physical health problems, which limits his mobility.
I meet with one of my young people who has been referred to our service with depression. On assessment it appears that she is actually functioning (eating, sleeping, attending college, socialising with friends) well and, in this instance, it is more of a low mood.

She tells me that her parents have just separated and her older sister has moved away to university and I spend some time normalising her low mood in view of the recent losses she has experienced.

We make a wellbeing first aid kit for her, which has a list of activities that she feels could help improve her mood when she is low. She came up with swimming, walking in the forest, candle-lit bath, listening to her Rhianna CD and painting her nails.
A colleague and I run child and adolescent mental health services (CAMHS) consultation sessions at two secondary schools.
We run these sessions once every half-term to allow school staff (usually year heads, teachers and SENCOs) to raise concerns they have about pupils who might not be in touch with CAMHS but are presenting with emotional problems.

We offer a mental health professional perspective to the teachers and help the staff to share their thoughts and feelings about the cases with each other.

It’s a great opportunity for the school staff to have this dedicated time to share their ideas and support each other. On a daily basis they don’t often have time to do this kind of thing because they are so busy teaching.

It’s also a really good way for us to maintain good working relationships with our school teachers, who often refer children and young people to our service.
I attend a Team Around the Family (TAF) meeting today to discuss support for a primary school pupil who has started soiling himself at home and at school.

The TAF meetings are arranged where unmet needs of a child have been identified and support from more than one agency/service may be required.

In this case, the boy’s father works long hours and is rarely at home. His mother suffers with depression and is struggling with being a full-time carer for her own mother who has dementia.

The family clearly have many needs, which are impacting on the boy’s emotional well-being.
I meet with one of the young people I work with who has obsessional compulsive disorder.

She has many rituals. One entails checking that all the windows and doors are shut and locked in her house before she goes to bed.

She has to check the windows and doors repeatedly for a couple of hours and worries that if she forgets to carry out this checking every night that something bad will happen to her baby sister.

We have had a number of sessions and have now progressed to a cognitive behavioural technique called ‘exposure with response prevention’.

The technique involves her gradually starting to confront her fears and, at the same time, preventing herself from carrying out her ritual.

It’s a gradual approach, so we agree that she will check one less window or one less door every night. This approach will then enable her to learn through experience that no disaster occurs when she reduces her compulsive behaviour.

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