Living in the Bearskin: Waiting Lists, Moral Injury, and Leadership in CAMHS

I have been revisiting the fairy tale Bearskin in preparation for an upcoming workshop. It is a story that helps me think about what it means to arrive depleted, and about the ethics of waiting when people, and systems, are under strain.

In the tale, a soldier returns from war with nothing. He has lost his home, his place, and his usefulness to the world he once served. Offered an impossible bargain, he agrees to live for seven years wearing a bearskin, unable to wash, groom himself, pray, or explain who he really is. If he survives the waiting, he will be restored. If he fails, he will lose what remains of himself. Much of the story unfolds in this suspended state: not actively rescued, not fully abandoned, but required to endure, unseen and largely unrecognised, until time itself does its work.

This story has particular resonance for CAMHS teams living with long waiting lists. Waiting lists have a way of becoming strangely abstract at scale: referred to in meetings as numbers, flows, or pressures, while remaining intensely concrete everywhere else, turning up in the consulting room, in inboxes, and occasionally in the middle of the night. Waiting, in this context, is not neutral time. It is saturated with anxiety, risk, and moral tension. Young people wait while symptoms escalate. Families wait while hope thins. Clinicians wait while knowing more than they can ethically act upon. This is fertile ground for moral injury: the pain of knowing what ought to be done, while being structurally prevented from doing it.

Many clinicians enter CAMHS already carrying the drain from previous roles, organisational turbulence, or cumulative exposure to distress. They arrive hoping to offer care, but often into services that are themselves depleted, stretched thin, and waiting for relief that never quite comes. Over time, the ethical strain of holding responsibility without agency can quietly erode professional identity.

If we use Bearskin as a scaffold for thinking, we can see how, in pressured teams, someone often becomes the “soldier” of the system. This may be an individual or a subgroup tasked with the grunt work: the action-orientated tasks and morally compromised decisions where ideals meet reality, and where risk, urgency, and unspoken fear are held so the rest of the system can keep functioning. Often this role is named only retrospectively, in the kind of conversation that begins with, “Do you remember when Jo was holding all of that?” - usually after Jo has already left. It emerges through goodwill, reliability, and a willingness to act where others hesitate, often in conditions that allow little time for reflection. Over time, the person may come to appear less morally intact, increasingly uncivilised or monster-like, as the group’s anxiety and moral contamination are gradually located in them. Leadership begins with a willingness to notice who may be living as though the war never quite ended, and to wonder what the system has been asking of them.

The bargain in Bearskin is not immediately violent. It is slow and corrosive. Over time, the soldier becomes unrecognisable, not only to others but to himself. Within the wider NHS system, CAMHS teams too can come to occupy this position. Similar bargains are made, particularly in relation to waiting lists. Capacity is exceeded “temporarily”. Risk is normalised. Supervision is postponed. Clinicians are asked to carry clinical responsibility without the conditions required to exercise it well. These bargains are often justified by necessity, but they exact a quiet moral cost, narrowing the space for thought and making ethical discomfort harder to articulate. To the “pure” NHS teams on the outside, such spaces can come to appear morally dubious or contaminating. The disturbance has been located.

The bearskin itself is a powerful image. It protects the soldier from freezing, yet isolates him from human contact. Teams develop their own second skins: inherited waiting lists, reputational anxiety, unresolved conflict, and the emotional residue of safeguarding work. These skins shape how teams are perceived by the wider system and how they come to see themselves. Over time, survival can be mistaken for resilience, and moral injury reframed as personal weakness rather than systemic failure.

What is striking in the story is the role of the youngest sister. She performs an essentially analytic function. While others are organised by the dominant narrative (that this strange figure must be a monster, a threat, something to be feared ) she refuses to collapse complexity into certainty. She does not deny the bearskin, but neither does she mistake it for the whole truth. She is willing to trust the unfolding dynamic, even when this stance marginalises her within the family’s preferred story of danger and contamination.

Every CAMHS team has figures who occupy this position: colleagues who resist premature certainty, question dominant narratives about risk or blame, and continue to think relationally when anxiety pushes the system toward defensive simplification. This role is often lonely. It carries its own risks, particularly in cultures where deviation from the preferred story can be experienced as disloyal or unsafe. Yet without this analytic function, teams lose the capacity to distinguish between threat and fear, danger and distress.

When the seven years end, Bearskin is washed, groomed, and restored. This is not an individual achievement but a relational one. For teams, restoration requires more than resilience rhetoric. It requires leadership that takes waiting lists seriously as ethical sites, protects reflective space, names moral injury without personalising it, and recognises that containment is a collective responsibility.

There is also something important about the symbolism of water in this moment. Across myth and group analytic thought, water is repeatedly linked with the unconscious: with what has been lived but not yet spoken, felt but not yet thought. The washing of Bearskin is not simply about the removal of dirt or disguise, but about symbolic meaning-making. What has been enacted in silence, urgency, and moral compromise is finally given words, sequence, and recognition. In group terms, this kind of washing is the movement from action into narrative: the slow work of helping a team put into language what has previously had to be carried in doing. Without this, action remains isolated and contaminating. With it, experience can be metabolised, shared, and re-entered into the group’s story rather than remaining lodged in one body or role.

Ultimately, Bearskin is a story about what happens when someone is required to carry too much alone, for too long, and largely in silence. Read this way, leadership in CAMHS is not simply about heroics or endurance, but about navigating an ongoing tension: between responsibility and constraint, care and capacity, knowing and not being able to act. It involves resisting the pull to treat waiting as morally neutral, while also acknowledging the realities that make waiting unavoidable. The ethical task is not purity, but discernment.

Senior leadership in CAMHS holds a particular responsibility in relation to waiting lists and moral injury, even as leaders themselves operate under significant constraint. Acknowledging that demand outstrips capacity is often only the beginning of the work. The harder task is to remain engaged with what waiting does to people: young people waiting for help, families waiting in uncertainty, and clinicians waiting in a state of moral tension between what they know is needed and what the system allows them to offer. This may require leaders to tolerate discomfort, ambiguity, and the limits of what can be repaired. Protecting reflective spaces, attending to emotional labour, and naming corrosive bargains are not guarantees of resolution, but ways of keeping the work human, and of reducing the risk that anyone (clinician or service user) is left to endure prolonged invisibility beneath a skin that no longer protects.