Exploring challenging treatment endings with Parent Champions

In March, the Anna Freud National Centre for Children and Families published a new report: In Search of an Ending. Managing Challenging Endings in Child and Youth Mental Health. Central to the report are views of young people and practitioners on why the end of child mental health support can feel like a difficult time, and the approaches that can help to make complex endings easier – both for young people and for those working in services. As a next step in this work, some of the Centre’s Parent Champions kindly shared their perspectives on these same issues.

Parent Champions emphasised that the end of treatment is a crucial time for young people and their families, and that there is potential for families to feel abandoned if endings are handled poorly. After long-term involvement with a therapist, one parent felt that their family had become reliant on the practitioner. This was an anxious time for the family. The parent felt that therapist had become so invested in the family that involvement continued for too long, and that the process of ending was protracted and lacked clarity. Reflecting on this experience, Parent Champions suggested that it is important to recognise that ending therapy can be challenging for all involved.

Power dynamics were also discussed in relation to endings. While participants believed that it is important for families to be involved in decisions about endings, they also shared that sometimes it can be hard to know when further improvement is unlikely, and when it is time to move on. In these cases, they felt that it can be helpful for the practitioner to lead in making the call.

Another focus of our conversation was communication – in particular when and how conversations about endings should happen. Parent Champions suggested that the practitioner should work with the family from early on to establish realistic expectations. This might include explaining that their time with a mental health professional is going to be one part of a whole set of things that help them live in a way that is healthier and happier for them and their child, and that what progress looks like for them might be quite different to what progress looks like for another family. But equally, Parent Champions felt that it would be helpful to be prepared for the possibility of needing professional support again in future, and that while there may be a measure of improvement, the difficulties their child is experiencing may endure for longer than the treatment period.

Parent Champions acknowledged that discussions about expectations can feel difficult and may need to be approached sensitively, and that it is helpful for parents to have support in managing their own expectations and emotional responses to having a child with mental health difficulties, and what may be an overwhelming desire for their child to be well. Nonetheless, they stressed that realistic expectations are important in helping parents and carers to feel prepared for the end of therapeutic support.

In terms of what else can help parents and families to feel equipped to move forward without professional help, Parent Champions highlighted the value of having a sense from early on in therapy of what else they and their child can try to support themselves– a kind of road map of non-clinical approaches. These might include diet, getting involved in activities and exercise and developing social networks. Knowing that there are things they can do without professional support can be hugely empowering, both for the child and family, alongside information about how to re-access professional help if needed.

The Anna Freud National Centre is working to find out more about self and community approaches to addressing mental health issues – which ones young people use, and why they help, so we can share this information widely. Do join our free Anna Freud Learning Network to receive updates about this work, including opportunities to get involved.