Unfortunately, if the child sustains adverse childhood experiences (ACEs) including trauma, separation and abuse, then there are likely to be resulting mental health concerns and challenges.

So planning for mental health for the family starts on day 1 of the infant’s journey in attachment and brain development.

If mental health challenges do arise, then the quality of socially and emotionally authentic relationships within the family are the key to helping the person with the mental health challenge.

The analogy often used in mental health involves the use of the oxygen mask on the airplane. The first thing to do on the airplane is for the parent to put on the oxygen mask and then the parent can help the child.

The parents have to take care of their mental health first in order to help the child.  The parents must be emotionally healthy in order to help the child.

The family system is an important part of our work at RCM Health Consultancy.   In family systems work, we look at the existing narrative within the family system.

The narrative is what the parent’s think. It is their assumptions about the child. If the problem has become entrenched and the parents have suffered with the problem for a decade or more, they might assume that nothing can be done. And then nothing will be done.

We recently spoke with the parents of a 30 year old child assumed to have “failure to launch”. The parent’s narrative and assumptions were that the child was not capable of becoming a productive and purposeful individual. When we offered to help with the narrative and assumptions, the parents said no thanks.  Nothing will change because of their assumptions which stopped any possible progress from being made.

If the narrative and assumptions can be unpacked and changed and a new more positive and optimistic outlook is adopted , then the ensuing changes in the conversation and actions might in fact work to help the child.  At least, an effort will be directed at changing in a positive and healthful way.

Challenges exist at this stage of implementing change, as well. Having the parents look at their own enabling behaviours is very difficult. It is hard work to change what is unexplored. Even if the parents had the best intentions in raising the child, things can go wrong.

Once the parents have examined their enabling behaviours,  and then changed the conversation and their actions including introducing consequences , then things might get worse before things get better. That is to be expected. So put on your seat belts for the bumpy ride and be patient.

This describes the family systems work that we do at RCM Health Consultancy when families commit to work with our teams in helping a family member with a mental health problem.

Raymond Rupert

CEO

RCM Health Consultancy Inc.

647 350 5500

info@rcmhealthconsultancy.com

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Uber complex implies high levels of uncertainty. Somewhat like a wicked problem. Not a complex problem.

The objective in using an expert panel is to go deeper in the analysis of the problem.

Hosting a diverse panel generates more options and more viewpoints.

We strive for diversity on the panel. Different disciplines. Different angles. Different styles.

With complexity, we don’t want to address the problem with a single lens.

We want to generate many diverse viewpoints. Then we want to seek consensus. Hard to get there but worth the effort.

Sometimes, we will do this blinded. The experts won’t know what each other thinks.

Sometimes, we will do this as an open discussion. Hard to reach consensus, if the opinions are ever shared.

For our current case involving the mental health and substance use disorder of a young adult with a history of self harm, we are going to start with a closed process. Like a delphi technique.

Then invite all the experts to an open discussion with each one knowing the opinion of the others first.

We hope that this process of using an expert panel delivers the best possible option for our client.

Experts should not be concerned that AI will replace them. Not yet.

Raymond Rupert patient advocate , former family doctor, founder of RCM Health Consultancy.

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I’m a clinical trials geek. I keep hearing people talk about the seven to 10 years it takes to make a vaccine and how dangerous speeding this up might be. The word that keeps popping up is “rushed”, and it is making the average person nervous about vaccine safety. So, as a clinical trials doctor, I am going to tell you what I do for most of those 10 years – and it is not very much.

I’m not lazy. I submit grants, have them rejected, resubmit them, wait for review, resubmit them somewhere else, sometimes in a loop of doom. When I am lucky enough to get trials funded, I then spend months on submitting to ethics boards. I wait for regulators, deal with personnel changes at the drugs company and a “change of focus” away from my trials, and eventually, if I am very lucky, I spend time setting up trials: finding sites, training sites, panicking because recruitment is poor, finding more sites. I then usually have more regulatory issues and, finally, if my big pot of luck is not used up, I might have a viable therapy – or not.

At this point, it might get delayed because of questions over profitability or any number of other obstacles. I’m not even going to go into the years it normally takes to get the “preclinical” studies, the ones before the human trials, done.

So next time somebody expresses concern at the astonishing speed the vaccine trials have happened at, point out to them that 10 years isn’t a good thing, it’s a bad thing. It’s not 10 years because that is safe, it’s 10 hard years of battling indifference, commercial imperatives, luck and red tape. It represents barriers in the process that we have now proved are “easy” to overcome. You just need unlimited cash, some clever and highly motivated people, all the world’s trial infrastructure, an almost unlimited pool of altruistic, wonderful trial volunteers and some sensible regulators.

With all of this and the clock ticking on a global pandemic killing people by the second, it turns out we can do amazing things. The vaccine trials have been nothing short of a miracle. A revolution in how we do trials that when you think about it is perhaps not that surprising given our ability to innovate when we really need to.

Three vaccines have already broken cover and demonstrated efficacy higher than we had hoped

And we really need to – necessity being the mother of invention. Safety has not been compromised. All trials have been through the correct “phases” or process of any normal drug or vaccine. Hundreds of thousands of the very best of us volunteered and had an experimental vaccine. The world watched so closely that when a single person fell ill, we were all debating it.

To date, there has not been a single associated death related to Covid vaccines and only a handful of potentially serious events. Just imagine watching everybody in a small city for six months and reporting every single heart attack, stroke, neurological condition or anything that might be judged serious. How astonishing is this? It has been a triumph of medical science.

I haven’t even touched on the lucky confluence of timing that meant this all happened at a time when sequencing all the genes in a person or virus is so routine nobody bats an eyelid. This turbocharged the early preclinical science needed as the foundation stone of several new technologies at the right point to be exploited.

At this time, three vaccines have already broken cover and demonstrated efficacy higher than we had ever hoped. The bar was set by regulators at around 50 per cent. Both Moderna and Pfizer reported 95 per cent efficacy, and Oxford University reported 90 per cent efficacy for a particular dosage regimen. Safety data is still to follow, but the track record of vaccines is excellent, and I am an optimist.

None of this is to downplay the challenges still ahead. It is also not to say vaccines are without safety questions still to be answered. It has been, however, a triumph of good process and great people. I am confident that when regulators pore over the safety and efficacy data, closely followed by every interested scientist in the world, that vaccines will only be used if their benefits clearly outweigh the risks – and you should be confident too.

Mark Toshner is a director of translational biomedical research at the University of Cambridge. This article first appeared on The Conversation

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