Dr Melanie Smart is clinical director of Chichester Child Psychology and specialises in infant, child and adolescent mental health. Here, she reveals what her typical day is like….
9am: I arrive at work and check emails for new referrals. It’s great to be back in the office after working from home during the pandemic. Although we continued with some sessions online, it’s not possible – nor ethical – to diagnose conditions such as autism via a screen.
There’s been a worrying increase in children with problems over the past year and referrals have increased five-fold since before the pandemic. In fact, for the first time in seven years of the service we have a waiting list of 15 weeks. That’s higher than NICE guidelines recommend and it’s frustrating, but we can only fit in so many families a day. We are a private practice.
Those I really feel for are families referred to Child Adult Mental Health Services (CAMHS) which has huge waiting lists. I suspect this is responsible for our rising numbers.
9.30am: We run a multi-disciplinary clinic meeting to discuss current assessments, interventions and referrals.
Risk assessment, safeguarding and care plans are reviewed to ensure everyone is kept safe and well. Then it's on to the first clinic of the day.
People often think that seeing a psychologist involves sitting in a quiet, calm space with a couch or a chair but with children it’s very different. Younger children lose interest after ten minutes of talk so our rooms are full of fiddle toys, Playdoh, colouring books and beanbags. You get so much more out of a child when they are doing a dot-to-dot puzzle.
This morning I see children who have been referred for a diagnosis of Neurodevelopmental disorder (Autism, ADHD etc). But it can’t be done in one session. It can take up to six hours of contact time and discussions with their teachers, parents and social workers.
11.30am: After the clinic, my colleagues and I talk through our findings and discuss our report.
Early diagnoses of conditions such as ADHD can help when it comes to support for children in school. It used to be a ratio of five boys to every girl but now it’s about six to four. That’s because while girls’ symptoms are more subtle, teachers and parents are more educated about what to look out for.
Watch: Living near green spaces may lower children's risk of ADHD
12.30: I break for a quick drink and a sandwich but use my lunch hour to liaise with schools and social workers so I can catch them on their lunch hours too. I’ll do some prep for the afternoon.
1pm: We run an assessment and intervention clinics for children dealing with mental health issues such as anxiety, depression, behavioural issues, OCD and eating difficulties.
I’m seeing more gaming addiction amongst children of all ages and I don’t think that’s down to lockdown, just the popularity of gaming over the last few years.
Today I see eight-year-old Mia whose parents are worried that she is hearing ‘voices’ telling her to do things. These voices are in fact ‘intrusive thoughts’ and part of an obsessive compulsive disorder. Treatment includes play work and role play and I’m confident we can help her fight the compulsions successfully so she can focus on being a typical eight-year-old.
I also meet Frances, who is 17 and has struggled with anxiety for many years following bullying and childhood trauma. Through a variety of therapies – including biofeedback (using the body to ground him and settle his nervous system) – we work together to help him feel more in control.
3pm: As psychologists, we’re often asked to assess and treat patients for insurance companies and private health and today I’m working with two boys who were knocked off their bikes by cars and sustained head injuries.
Although the physical scars are healing, they’re suffering from post-traumatic stress disorder (PTSD) and our work will enable them to move forward, both with their mental health but also with any ongoing litigation.
4.30pm: Before COVID, we ran group sessions for issues such as self-esteem, adolescent identity, positive parenting and infant mental health but it’s not possible right now.
However, we do the odd ‘walk and talk’ session with older teens who don’t want sessions online but do need to speak to someone. Being outside in nature relaxes them and they can often be more open to discussing their problems when they’re not in the confines of a room.
6pm: My official finish time but evenings involve report writing, admin, research and keeping up with new guidelines and training. I teach for the local universities - always fun, inspiring the next generation of clinicians.
Sometimes I’m asked to do more ad hoc work, such as acting as an 'appropriate adult' for an under 18 in a police interview, expert witness court work or delivering some training to local services.
At the end of the day, it’s good to be able to leave the office rather than simply close the laptop and still be in my own home.
Switching off, when you may have heard some particularly traumatic stories that day can be hard. When I first qualified, I’d find myself writing up case notes or letters in my head, even when I was on holiday. Psychologists make use of peer-to-peer supervision where fellow professionals will support each other both practically and emotionally and it is invaluable.
I would like to say that I do something wholesome like yoga to unwind but really it's a glass of wine and 'True Crime' by nine as a rule. I love my job and the profession and wouldn't swap it for the world.
Watch: After nearly a year of quarantine, 68% of parents believe their child's social skills are now 'stunted'