I have now moved my practice to the Young Person's Specialist Substance Misuse Treatment Service YPSSMTS in Bristol where I have been since May 2023.

Recently I returned from the International Association of Youth Mental Health IAYMH Conference in Vancouver, where I presented a poster about our service and attended the whole day workshop on substance misuse issues. Before I even got to the conference I had life changing events in  seeing my Winnipeg relatives for the first time and learning from them about the fate of the  First Nation, who were ethnically cleansed and traumatised by the practices of the Catholic Church and local authorities in Canada for 150 years until the mid 1980s. I had a sense that something is missing in Canadian life and my reflection here is about the loss to our world of the precious lives, memories, knowledge and love of indigenous peoples in history.

I could write several blogs at this point but today I want to start writing about ENGAGEMENT. In our work we see young people whose lives are threatened by the impact of depression in the setting of trauma, abuse, exploitation and problematic drug use. In North America the annual death toll from opiate use being around 100000 with no sign of marked improvement in treatments for young people. In this specific example it is not just about giving Methadone or Buprenorphine or Suboxone; it is more about giving the engagement young people need. When a young person is using Class A drugs their life is at risk from fatal overdose. The unspoken communication here is that their lives are on the line are we are challenged to meet them and save them.

In North America people can have emergency treatment and assessment after overdose but ongoing care needs to provided by a specialist who cannot be accessed because they are not available or the young person cannot afford the health insurance or the consultation fees.

Although in the UK we do not see many young people taking opiates the principle of meeting a young person where they are at in their point of crisis is very important.  In my conversations in Canada and Bristol, I have learned that it would be good to write about engagement. It is an area that needs more research and can be explored to discover universal principles which can help clinicians and people understand, related to and connect with a young person (under the age of 30 years, according to my conference learning). 

First Meeting

At first meeting it is good to consider being with another person to make it a more easy going three way shared conversation. I prefer face to face meetings over on line meetings. We live in a world in which online meetings are normalised as the way to be, the way to work and just what we need to do. However a bit like being in Canada.... something is missing...

A face to face meeting is a real meeting. A mental state examination cannot be done properly in an online meeting or over the phone. We can have more efficient mental health contacts on the phone or in a video meeting, but something is missing and too much is missed altogether. One could argue that a remote meeting can engage a young person in a remote rural location in Australia or support with initial engagement with someone with ASD who has sever social anxiety. However really being present in the room opens the door to your involvement and commitment to the best care for the young person. We bring hope for change and a new direction to a young person who is stuck in their current crisis. The crisis may relate to being in two minds about living or dying or being in the grips of an eating disorder or being subject to abuse/exploitation or struggling to deal with coming out or gender issues. Some young people may find it difficult to connect with their feelings, know what they are thinking and express their views.

The initial meeting is where we give a young person time to talk about what they want to talk about. In the conversation the young person will teach us what they are worried about and express their issues in their own words. We need to use our skills of empathy to understand the young person's story and how they want to be seen in the world and explore with them the limits of their thinking and ideas. We invite them to go slightly beyond what they know in order to give them the hope for change. Yes, it will get better.

If we have had a good first conversation, then we can get to the safety plan and more importantly look forward to the second meeting. The second meeting is the subject of the next blog.