An Interview with our Guest Contributor, Dr. Sara Ireland

"I’d rather focus on understanding the relationship with the behaviour and the conditions under which it visits and address it without labelling the person as we then add a layer of shame which might limit the scope for change. A focus on creating healthy relationships and the conditions in their family that are likely to engender those, create relevancy and are more likely to change longer term relationships and family connections."

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From a dynamic career spanning the NHS, consultancy, and innovative community projects, Dr. Sara Ireland, the CEO and Clinical Lead of Atrium Clinic and Wellbeing Centre has always been driven by one goal: to make a meaningful difference. In this Guest Contributor interview, she shares how her diverse experiences shaped her journey to Atrium Clinic, her commitment to real human connection in mental health services, and her vision for empowering clients to take charge of their mental wellbeing. You’ll also gain insights into the pressing challenges facing workplaces today, the clinic’s impactful family-focused approach, and the unique ways they champion neurodivergence and resilience.

Sara Ireland is a chartered psychologist (Occupational and Coaching) and a psychotherapist, a group facilitator and trainer with additional post graduate clinical mental health training. She has been involved in the Forensic Sector since 1986 through charities, the NHS and through Atrium Clinic which provides therapeutic services across London prisons. Atrium Clinic is an accredited therapeutic training provider and an NHS contractor, a clinical neurodivergence service provider and Sara and colleagues are trained in family intervention and parenting support. She has worked as a specialist clinician in social care, with youth offending, disabilities teams and families and led multi- agency community projects and clinical teams; nominated for national awards for her work in diversity and inclusion and more recently for her contribution to our understanding of self-harm in families, developing Communities of Practice, and her research on the work with doulas with women who have had contact with the criminal justice system. She also leads the Atrium Clinic Clinical supervision training programme, contributes to the accredited training programmes and mentors underrepresented groups who want to enter psychological professions.

Please note, all views reflected are the individual’s own, and not representative of their employer.

Can you share the journey that led you to become the CEO and Clinical Lead of Atrium Clinic and Wellbeing Centre?

I started in NHS in direct therapies, training and NHS manager posts and then moved into NHS organisational development and strategic management as thought I could change the things about the NHS that frustrated me. (Youth!!) Following this I left the NHS altogether and went into consultancy with blue chips and public services on leadership, HR, business, coaching and change. I got frustrated as it seemed somewhat meaningless work and returned to the NHS in management and then clinicial roles in disabilities services, early help and adult social care. There were innovative community projects such as Birth as a Medium for Change, aware how tough it can be to parent. A clinical supervisor role in family intervention and digital therapies followed as I felt I needed to learn new ways of developing services. Finally, I found Atrium Clinic, a small business but ambitious to make a difference to those who needed help most and to explore new evidence-based ways of supporting people. I love working with great colleagues, passionate about improving how we work in the client interest.

How does Atrium Clinic integrate ‘real human connection’ into its nationwide mental health and wellbeing services?

My frustrations with historic service designs are that they have often not reflected the needs and wishes of those who use them. I recognise the role of co-design of services, peer support and lived experience, family involvement with clients and optimising flexibility to access and the method of engagement and delivery to suit the individual ‘s needs. Atrium works hard with the client to shape the service that they want, and we are small and flexible enough to be able to do this. We have a lovely team of service coordinators who are available to the client between appointments with their practitioner. Some of our clients in distress look forward to daily wellbeing check- ins from their service link and tell us that they feel really understood and cared for. It’s the care we give and going the extra mile that helps a client recognise that they are valued and not a burden. They can then express that care for themselves and others!

In your experience, what are the most pressing mental health challenges faced by individuals in the workplace today, and how does Atrium Clinic address them?

There are some contradictions going on in the workplace. On the one hand, we have better employment rights than ever – better opportunities for parental leave, access to subsidised childcare, more chance to talk about ‘struggles’, flexible working and appreciation of individual differences. Adjustments made for people with conditions such as neurodivergence, menopause and mental health issues as well as an awareness of work life balance and personal boundaries. Unemployment rates are currently relatively low and yet an employment squeeze has led to more stress being reported and increased sickness absence related to chronic conditions and mental health have consequences for the wellbeing of all.

Of course, the wider cost of living increases, reduced public services and poor access to primary health care and SEND services are part of the story. Social media use plays its part in withering attention spans and persistence, a focus on bad news over good news in the world adds a sense of gloom. I think there is also hopelessness and less optimism that the last generation’s attainment of security, a safe home, the links between education and training and a ‘liveable’ income and care if you need it and a ‘good life’ might not be open to you. There are additional struggles because we are living longer. The ‘midlife people’ are dealing with adolescents at the same time as having elderly care responsibilities. These are more onerous as the state retreats and young adults are more dependent on their parents for longer with consequences for family life. Flexible but remote working for the young may reduce learning opportunities, fun, connections, and the chance of lifelong friendships through work.

We work with every client in the way that suits them, creating a space that is safe and present but also widens perspective and supports them to re-tool for the life they want to lead that recognises mindsets, strengths and bonds that support them. We encourage our clients to hold themselves with affection! Our clinical outcomes are well above community average, and we use a health and social history in an assessment and understanding of their context and metrics consistently to track wellbeing and goal attainment with the client. Whatever the service pathway, every client deserves us to work as hard as we can with them to help them make the lasting changes they value.

Atrium Clinic offers a range of self-assessment resources. How do these tools empower individuals to take charge of their mental health?

When people get to know themselves and their patterns of wellbeing, they often enjoy self-monitoring over professional monitoring, and this can be empowering and light touch! When they are watching TV or scrolling through social media, clients tell us that they add in a self- inventory, helping them review goals or re-start things that they may have stopped doing! They enjoy sharing tools with friends and family and having conversations about them. They are managing their own wellbeing and learning about themselves and making choices.

With your extensive background in coaching and occupational psychology, how do you approach supporting neurodivergent individuals in both personal and professional settings?

I’ve always recognised the uniqueness of people as a contributor to our societal effectiveness and the potential of everyone to develop and change. We can lose jobs, money, people we love and status as fast as we can gain the same but there is an element of consistency about a few key factors that make us ourselves and a unique opportunity to grow into our strengths and address areas we want to improve. ‘Neurowiring’ is unique to us all. The cut off points for diagnosis and the overlap between diagnoses mean that to focus on our own traits and patterns, to learn about ourselves and the wider impact of our cumulative experience and what supports us to bring our best selves is part of the journey. Those at work given a diagnosis of neurodivergence are often relieved to have a greater understanding of past difficulties as well as strengths. It can provide a framework for conversations with their employer about their needs. For many people who do not quite fit diagnostic categories or have similar difficulties in functioning from traumatic experience, there are gains to be had from understanding their unique brain wiring the reasons for their difficulties and the strengths that they want to nurture. Neurodivergent people are individual and there are huge differences between them. I am from a neurodiverse family, and this has clearly impacted my own parenting and the family space we have created but the opportunity to learn about yourself and others’ preferences and commit to a pathway of self- improvement is a worthwhile endeavour.

Atrium Clinic collaborates with various health partners, including the NHS and community services. Can you elaborate on the importance of these partnerships in delivering comprehensive mental health care?

We’ve always worked alongside the NHS mental health trust providers and services such as local authorities and GPs. It’s not always easy in a world of volume targets and pre-set evaluation matrices which don’t always reflect what our clients tell us is important to them. We try to be good partners and our subcontractor role in the NHS exceeds twenty years. We often do more than they ask us and report more on clinical outcomes than they request so we can be part of shaping the future of commissioning in the client interest. We seek to do pilot work as part of contracts and are trusted to work safely and professionally. We have trained and supervised our NHS partners in some of our practices so we can all benefit from our shared learnings from practice. When we work with the NHS or the wider professional helping system, we recognise the demands and constraints on them, the importance of shared risk management, effective communication and client consent and transparency. We seek our partner’s feedback on how we work and aim to provide seamless service to the client.

Reflecting on your work with institutionalised individuals, what strategies have proven effective in fostering personal growth and reintegration into society?

People are often institutionalised for a period in their lives and when it is prison, the losses and trauma are huge. Loss of safety, security of a home, family disintegration and work. When punishment finishes, they return to a community stigmatised, more emotionally damaged, and more isolated. Even individuals in contact with justice and statutory social care services face stigma, distress, lack of trust and anxiety which can render them more unsafe and disadvantaged. We believe that knowledge, information and a sense of self or mission can support individuals and their families to move forward in what can be a very hostile environment. Being able to navigate the system of help, support and connections can be useful too. Many of the clients we work with have had very distressing childhoods and encountered much difficulty in their lives, but their resilience is astounding. When we begin to help them navigate systems and appreciate their own story and build skills that move them towards their goals, lives are changed for the better.

From your perspective as a psychologist, how do experiences of domestic abuse impact mental health across different life stages, and what role does therapy play in supporting recovery?

We are learning more about vulnerability of domestic abuse for all those in partnerships. I sometimes struggle with the notion of perpetrator and victim because I believe we can be both, at different times or contexts of our lives or in a partnership with others. The so-called ‘bully at work’ may be a ‘victim in the home’ or the bully at school is the abused at home. I’d rather focus on understanding the relationship with the behaviour and the conditions under which it visits and address it without labelling the person. Labelling adds a layer of shame which might limit the scope for change. According to research, a focus on creating healthy relationships and the conditions in a family that are likely to engender those, create relevancy and are more likely to lead to change in longer term relationships and family connections. There are certain contexts when labelling accompanies our work to intervene and support that exploration and goal for change.

What we know is that our story with domestic abuse may start as a small infant, feeling unsafe in our family. At that point our brains attune more for danger, and this can reduce our attention for other emotional development and wider learning and normalize harmful relationships. Research tells us that domestic abuse at any age is linked to poorer mental health and emotional regulation. People who feel unsafe are not able to be fully present to life’s pleasures. We are exploring the use of gaming and Virtual Reality to support families with lived experience of domestic abuse to access others’ experience as well as their own to provide new routes for reflection on their stories and create the pathway to change.

The For Baby’s Sake Trust focuses on breaking cycles of domestic abuse and giving babies the best start in life. How does Atrium Clinic’s approach to family therapy and support align with the objectives of the Trust?

Atrium Clinic is aligned with The For Baby’s Sake Trust’s objectives. We are family focused in the way we work but prioritise the needs of the infant and an understanding of the family members preferences for learning so they can engage well with their own story and how it meets with their goals for a family life where their child can thrive.

In what ways can mental health professionals collaborate with organisations like The For Baby’s Sake Trust to create safer and healthier family environments?

Atrium Clinic works at the outset to identify the right metrics with families and stakeholders so we can work transparently with risk and safety to assess the impact of the work on family relationships and their goals for change.

Given your expertise in psychological resilience, what strategies do you recommend for individuals and families recovering from the trauma of domestic abuse to rebuild their emotional wellbeing and sense of safety?

From the outset we have been utilising mental toughness concept metrics with young people in some of our projects and feeding those indicators into our development work as part of the preparation for recovery. Resilience, in the sense of bounce-back from setback, is a key ingredient in recovery but bounce-back without reflection and change leads to negative cycles of behaviour. For some people, resilience is their strength and a survival strategy after much adversity but survival in a maladaptive cycle of behaviours is not a desired outcome here. We need to encourage unpicking the story of abuse, strategies to support a thoughtful self, an understanding of your own role within your story, a calm environment and to recognise and practice thinking and behaviours that offer a different response for the future.