Since Kenny Ross joined Greater Manchester Mental Health (GMMH) NHS Foundation Trust as a consultant adolescent forensic psychiatrist in 2000, he’s worked with children and adolescents in the community, including those in secure children’s homes or young offenders’ institutions. He loves his job so much that, although technically retired, he’s staying on part-time in an area of his role that he found particularly rewarding: working with young male offenders in Barton Moss Secure Care Centre.
Barton Moss is run by Salford City Council on a contractual basis for the Youth Custody Service. Recently rated outstanding by Ofsted, it houses up to 27 boys. Ross says that boys on remand typically stay at the centre for very short periods, while those serving sentences as a result of criminal convictions are there for a minimum of eight weeks. Some, however, remain at the centre for much longer, says Ross – those serving life sentences will be there for years before transferring to an adult prison at the age of 18.
Supporting troubled adolescents with a history of violent behaviour is never going to be everyone’s cup of tea. And yet, says Ross: “Looking back in my career in adolescent forensic psychiatry, I’ve never been assaulted or threatened.” Psychiatry as a profession attracted him because it was a job that allowed him to spend time with patients. “Your relationship with them is a really big part of what makes the difference.”
To Ross’s young clients, he is always Kenny, not Dr Ross, and he makes a point of remembering what they’ve told him previously. “If I know that their mum was poorly or that their sister was doing her exams, it’s really important to me to ask about that. And there’s something about that that then makes it easier for them to tell me other things.”
The tier 4 child and adolescent mental health services (CAMHS) department of GMMH offers a range of services along with community-based provision, which includes in-reach clinics at two local authority secure care homes. The tier 4 CAMHS service also has two inpatient units: Junction 17, for young people aged 13 to 17 with complex mental health difficulties, and the Gardener Unit, a 10-bed unit for boys aged 11 to 18 with significant psychiatric disorders. Junction 17 is located in an award-winning purpose built environment and the Gardener Unit is a medium secure service for male adolescents – one of six national adolescent medium secure (tier 4) services in the UK. In April 2018, GMMH also took over responsibility for Bolton’s community-based CAMHS for children ranging in age from five to 18.
The breadth of the offer provides scope for professionals to develop their expertise further in this speciality, while meeting the service needs. Patients come to the service with a variety of conditions and difficulties, including depression, self-harm, experience of abuse and post-traumatic stress disorder, schizophrenia and anxiety. They are treated by an experienced multidisciplinary team that includes psychiatrists, psychologists, social workers, occupational therapists and dietitians. The model of care, says Shermin Imran, consultant child and adolescent psychiatrist, who has worked in the inpatient service for the last 10 years, “is to equip them to develop resilience and work towards recovery”. The young people are offered individual, tailored therapies, including medication and talking therapies, and the team works with their family and carers, as well as with the young person. There are also partnerships with agencies such as the local authority, to make sure that educational and housing needs are met.
Bethany Whittaker, 23, can vouch for the importance of teamwork. As a 17-year-old, she spent six months as an inpatient at Junction 17, suffering from anorexia. She describes a “holistic approach to care” that involved multiple professionals supporting her, including one, an occupational therapist, who, in the run-up to Christmas, took her home so she could decorate the tree. Now a registered mental health nurse herself, she works with inpatients at GMMH.
Whittaker’s experience reflects the supportive culture at the trust. “The ethos that patients are at the core of things is true for our trust – I don’t think it’s something that’s paid lip service to,” says Ross. He likes the fact that the trust is very non-hierarchical: “I could walk into the trust HQ and I will recognise most people and know them by name, so there’s no divide.”
Part of Imran’s role involves recruiting and training higher specialist trainees, who she describes as an “important part of the clinical work that we deliver”. One of the attractions of working for the trust for Imran is the opportunity it provides for professional development: “If you wish to develop new competencies and you want to expand your role or want to do different things, as far as possible, the trust will help and support you in doing so.” She, herself, is both a regional representative and an examiner for the Royal College of Psychiatrists – the latter is voluntary, but “an exciting role for somebody who’s interested in training the doctors of the future”.
Ross has found that the trust’s role as a centre for training and teaching has meant that medical students come and observe him and his colleagues at work, which places the clinicians at the heart of training the next generation of medics.
The trust also offers staff opportunities to get involved in research. As well as a long-established psychosis research unit, it has also set up a young person research unit, which aims to work closely with the CAMHS clinical teams. Any new research the unit carries out will “come from the ideas of the clinical team and from the young people within our services”, says Imran.
All those elements – the CPD, the research opportunities, the supportive atmosphere – help explain why a doctor such as Ross has never wanted to work anywhere else. He says the “best bit of the job” is the enjoyment he derives from working with his young patients. Frustrated with the British attitude towards adolescents – “We can never say a positive thing about a teenager” – his experience has been the opposite. “For me, it’s been an absolute joy. I love it, I absolutely love it.”
