The tweet sparked outrage and national media coverage. But mental health professionals and charities weren’t surprised. Mental health services have always been underfunded and, since the start of austerity cutbacks in 2010, the situation has got worse. NHS spending on children and adolescent mental health services (CAMHS) in England has fallen by more than 6 per cent in real terms since 2010. Because of bed shortages, mentally ill children may be treated hundreds of miles from home.
The disjointed and patchy services for children and young adults means many are dealt with punitively rather than medically. They find themselves in prison or held in custody, rather than in hospital or receiving therapy in the community. Once young people are in the criminal justice system, it’s even harder to get them mental health support.
Policy and practice varies in different places. Some youth services stop at 16. Adult mental health services start at 18. What happens to those young people who fall through the gap?
Kesia Leatherbarrow was a lively child with a mischievous smile. Sometimes her enthusiasm landed her in trouble. Like the time she spotted a mouse one morning on her paper round, scooped it up her sleeve, and headed off to school. Later that morning her mother, Martina, a science teacher and department head, received a phone call: Kesia was in hospital with a swollen face because of an allergic reaction to a mouse bite.
Martina smiles and hugs her arms tightly around her small frame. She has the same thick chestnut brown hair and alert brown eyes as her daughter. “Kesia liked all animals. Do you know Elmyra, the cartoon? She’s a cartoon character that loves animals and squeezes them so much that they can’t breathe, that’s what Kesia was like.”
When Kesia was well, mum and daughter had a happy relationship.Kesia would lug her accordion to their bathroom and play while Martina relaxed in the bathtub.
Kesia played well. She performed at charity events and competitions, was principle accordionist in a children’s band, enjoyed being the centre of attention. But in the bathroom with her mum was her favourite place to play.
“I was only 17 when I had Kesia, just before my 18th birthday. It was a surprise,” says Martina. “But there was never any doubt that I was going to do everything I could to make her life better and to give her a good life.”
Martina and Matt, Kesia’s stepfather, an assistant head teacher, were devoted to their only child. By the time she was four Kesia could read and recite the periodic table. As she got older Kesia poured her energy into everything; scuba diving, holidays abroad. “She loved excitement. She loved theme parks and roller coasters. She was just so much fun.”
Between the ages of 12 and 14 Kesia turned inward. Her energy became rage and would often erupt. Trivial misdemeanours, fiddling with her ear stretcher or chatting in class, would escalate into Kesia screaming and shouting at her teachers.
She started cutting her arms and legs. “Kesia was extremely academic and very able,” says Matt, “but didn’t quite fit the mould of what’s expected of all children. She struggled with that. The school were punitive in their response.
“There is so much you can do for a young person, however all they ever did with Kesia was to warn and punish, warn and punish, warn and punish.”
Martina and Matt needed help. They tried their local Children and Adolescent Mental Health Service, but staff refused to meet them face to face and dismissed them over the phone more than once.
The thresholds for accessing children’s mental health services are high. They were told, time and again, that Kesia’s problems were behavioural and not a mental health concern.
But Kesia was more than just an angry teenager. Something was deeply wrong. Even now Martina and Matt struggle to define Kesia’s illness. It wasn’t a quiet or episodic illness, Kesia’s anger was constant, intense, raw. It came in violent waves that would devastate her family.
“Round the clock for years firefighting,” says Matt. “Kesia’s not going to get her GCSEs, Kesia’s not going to sit her exams. Kesia’s not going to get her college placement.”
These practical considerations had to take second place to what was happening inside Kesia’s head. Day to day, hour to hour they tried to understand, manage and soothe Kesia’s mental illness. She knew there was something wrong, something wrong with her brain, Martina says quietly, “and no one could tell her what.”
When she was 15, Kesia was permanently excluded from school for possessing a small amount of cannabis. Her parents knew they would lose an appeal.
“You know the behaviour was wrong, it was a damning case. We couldn’t have dealt with it,” says Matt.
Any pastoral support from the school for Kesia should have come before things deteriorated, they reasoned; it was too late for that. They accepted the school’s advice that Kesia could sit her GCSE exams at a special short stay school. “They guaranteed that they would enter her for her exams,” says Martina, still angry. “They didn’t enter her for any of them. I was so angry at the time. Kesia was upset.”
Early on in the summer of 2013, Kesia, now 17, stopped eating. Her body weight dropped to six stones (she was five foot four). She crumpled and seemed to wither. Where she once screamed and lashed out, now she only whispered.
When Kesia’s illness manifested in rage and ‘misbehaviour’, Martina and Matt had found it impossible to get help for her. Now that she was quiet, docile, broken, help came, but briefly.
A local mental health crisis hospital accepted that Kesia was ill and gave her a bed for five weeks. She was put on anti-depressants (20mg of sertraline, later increased to 50mg) and given counselling. “She began eating again and started putting on weight. She was absolutely loving, too,” says Martina.
In the two weeks after she left hospital outreach and crisis teams met with Kesia three times, but when she started missing appointments they discharged her completely. Once again the family was alone.
Rebecca Omonira-Oyekanmi is a freelance journalist and writer in residence at Lacuna: Writing InJustice. Her reporting on asylum and undocumented migration was shortlisted for the 2012 George Orwell Prize for Political Writing (blog category) and the 2013 Speaking Together Media Award.