When the client smells

When faced with a young client who smells, life becomes problematic for me. Not because I wish to magic them out of their awful situation (which of course I do want because I’m human) but because I’m never quite sure which way to jump and who should do the jumping.

I’m not talking about a child of four or five who smells of wee, nor a teenager who has yet to discover deodorant – though each of those will need dealing with by someone at some point. But when you are faced with a very smelly 14-year-old and the smell is all-encompassing, you know that something is going wrong at home. Cue, child protection considerations.

But wait, I hear you say. Isn’t this blog about mental health? Well, yes. But the ramifications for an unclean child are many:

Someone presumably isn’t providing care
The child must be struggling alone
Physical and mental health can become enmeshed
Friends either don’t exist or desert – at 14, that’s serious.

So what are my options?

School nurse? Not all schools have them. Social services? A possibility. Filling in a CAF seems overkill. A word with the parents (if I can contact them) often brings only temporary results, and school staff ditto.

But oh please, not the counsellor. Not me. How am I meant to be accepting and supportive, “on side” and a safe place, if I tell the young person they smell? (On the other hand, where does congruence fit in here?!)

At times like this, I become acutely aware of joined-up working with all the other professionals involved with young people. That way, while protecting my role (or fleeing the unthinkable), I can ensure the child’s needs are met.

One excellent book of case studies that makes for good and informative reading around these wider contexts is Case Studies in Child and Adolescent Mental Health.

This sounds a tad daunting so I’ll mention the contents:
Oppositional defiant behaviour
Adolescent depression
School refusal
Intellectual (learning) disability
Parental divorce and separation
Looked after child
Asperger’s syndrome
Anorexia nervosa
Hyperkinetic disorder
Obsessive compulsive disorder
Somatisation
Conduct disorder
Post traumatic stress disorder
Deliberate self-harm I: overdose
Deliberate self-harm II: self-injury
Schizophrenia

The author works in Walsall, UK, and there are references to smelly children, so I feel it is grounded in reality! It doesn’t solve my dilemma. Just eases my intermittent worry that I, alone, might be expected to sort out a child’s total problems. Which is how it can feel if we forget about joined-up working and a multi-agency approach.