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Unidentified child abuse is pervasive - it affects every aspect of your life

Clare Jerrom talks to Dr Anna Preston about leaving the NHS after 16 years, joining WillisPalmer as a Consultant Clinical Psychologist, taking a lead on the quality assurance of all psychological reports and why it is imperative that vulnerable children experiencing neglect or abuse are identified immediately and sign-posted for help.

When Dr Anna Preston was growing up, her father was employed by the Department of Health and worked in high security mental health hospitals. While many of her peers at the time may have been fearful of the inpatients at these settings, fuelled by damning and unhelpful media headline’s such as The Sun’s ‘Bonkers Bruno’ headline following the boxer’s admission to a psychiatric unit, meeting in-patients at high security hospitals was a regular feature for Dr Preston.

“The patients put on a show every year and the workers and their families could go along. It showed me that the people within these hospital settings were just like you and I but had gone down a different path. It highlighted that no one is immune from mental health problems,” said Dr Preston.

Anna gained a very real insight into the experiences of people who were unwell, regardless of their presentation of needs, and this enabled her to empathise with others.

She remembers clearly thinking ‘I’m going to do that job, and I’m going to help people like this’. She didn’t realise it would take her 11 years after that to qualify.

Making a difference in a short space of time

Dr Preston became an assistant psychologist in October 2003 at The Priory Hospital in Woking, working with people with acute mental illness and substance misuse problems. She held a number of assistant psychologist roles before completing her Doctorate and becoming a Specialist Clinical Psychologist in Acute Therapies at the Personality Disorder Services of Surrey and Borders Partnership NHS Foundation Trust in October 2009.

In fact, Dr Preston spent 16 years working for the NHS before she stepped down from her role as Consultant Clinical Psychologist and Trust-wide Lead for Acute Psychiatric Care at Surrey and Borders Partnership NHS Foundation Trust in November last year.

Having worked for WillisPalmer for the last 10 years writing expert witness reports, Dr Preston is now an independent clinical psychologist and has joined WillisPalmer as a Consultant Clinical Psychologist and will be taking a lead on quality assurance of all psychological reports.

“As an independent Clinical Psychologist carrying out expert witness reports, you can make more of a difference in a shorter space of time. Having carried out assessments for WillisPalmer for the last 10 years, I already had a relationship with the organisation and some of the people who work there, especially since the Multi-disciplinary Family Assessment service (MFA) has been established and so when this opportunity came up, I felt it was the next step in my relationship with WillisPalmer. I have found the team to be welcoming, helpful and supportive, which is an approach that I liked,” said Dr Preston.

Pieces of the jigsaw

Having carried out expert witness reports for the last 10 years, Anna brings a wealth of skills and expertise to her new role in the quality assurance process as well as experience in knowing what information a psychologist will require. She says her report writing skills have improved over the years and are refined given how many assessments she has carried out, which will ensure that she has the required attention to detail when quality assuring the psychologists’ reports.

She has an abundance of expertise having carried out assessments for the family courts in relation to a broad range of issues from mental health problems, cognitive functioning, forensic risk, capacity to parent and substance abuse.

Dr Preston has also been highly involved in the Multi-disciplinary Family Assessment Service (MFA) whereby following a referral, WillisPalmer's multi-disciplinary team, which can comprise social workers, psychologists, psychiatrists, therapists or family support workers depending on need and the problems presented, work together to assess the family and their parenting capacity during an eight-week period. At the end of the eight weeks, a report is produced with advice and recommendations for the local authority.

“The MFA brings together whichever disciplines are needed to bring the pieces of the jigsaw together. This starts at the very beginning of the process, the first meeting, and continues throughout. There are frequent meetings and ongoing communication. It has been evident in cases where, for example, there are safeguarding issues, when all the pieces of the jigsaw are not working together, then problems occur,” said Dr Preston.

Pressure cooker

“I try and assess someone early on so that if issues are raised, the different disciplines can adapt their approaches especially if I have identified that somebody has ADHD, is on the autistic spectrum, has other developmental issues, learning disabilities or mental health problems. I can make recommendations right at the beginning that the process has to be adapted in a certain way. This is not only helpful for the adults involved, but if the adults are being more effective, it will impact on the children we are assessing too,” she explains.

Because the various services are working together over an eight-week period, it allows the family time to explain their experiences and provide their perspective rather than a one-off assessment where they might feel under pressure. “Families are in their home environment so in a familiar setting and the whole approach is supportive and open. This is vital – especially when adults have trust issues. They need to understand the process and be able to explain their experiences,” said Anna.

Dr Preston highlights that this approach is even more attractive in the current context of COVID where people have lost the human face-to-face contact with people, the services they used to attend, the groups they used to go to, which is significant. In addition, there is the pressure cooker situation where sometimes large families are contained together within four walls, with emotions heightened and worries about physical, mental health or finances are exacerbated.

It is massive, it affects every aspect of their lives

“The MFA brings back into existence the human contact and support that they have lost and which many people are missing. As the assessment is multi-disciplinary, it enables us professionals to work out what the problems are whether they are in need of financial assistance, respite, help with mental health problems and work out what the specific solutions are. If a psychological issue is identified sooner, it is easier for us to see that it is not money that is a problem, for example, it’s a mental health problem and now we can recommend support. It makes a difference to the whole system and enables children to stay at home where it is safe to do so,” explains Dr Preston.

In terms of vulnerable children potentially experiencing neglect or abuse during the last 10 months where there have been three national lockdowns and varying restrictions, Dr Preston says it is unsurprising that the spike in referrals to children’s services did not occur in September as anticipated given that tiers were introduced shortly after as well as the lockdown in November prior to the latest national lockdown announced earlier this month.

“If these vulnerable children are not identified then in the immediate term they are at risk of physical harm, injury, poor emotional wellbeing, development problems. If they are experiencing trauma or abuse, it could affect everything from their emotional wellbeing, to being able to achieve at school, attachment problems, mental ill health, poor social functioning and physical health problems.”

“For vulnerable children, it is massive, it is pervasive and could affect every aspect of their lives both now and throughout adulthood. If abuse is not identified or there is a question mark about it and it is not addressed, these children will be significantly affected both now and in the future years to come,” she concluded.

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