State of Mind
01 June 2015

It was just another day in the practice.

Sharon, 14 years old, smart and able to talk for herself, told me of months of struggling at school and being bullied. She had become troublesome and disruptive in class, and had been suspended. At home she spent hours alone in her bedroom, refusing to talk to her mum, staying up until the early hours, self-harming and thinking dark thoughts.

She was hearing voices, shouting at her, telling her to end it all. Her hands were white with wringing and tears ran down her cheeks.

It didn't take much to realise she was deeply depressed, maybe even psychotic, and was at considerable risk.

I needed specialist help for her, but on making the call to the emergency psychiatric services I was offered an out-patient appointment in three weeks.

I explained again the urgency of the problem but to no avail. Arguing the case for my young patient, I was told I was being verbally aggressive.

"And what shall I tell her family if she commits suicide this evening?" I asked. "Shall I tell them you don't consider it an urgent problem?"

Tony, meanwhile, is usually a pleasant, quietly spoken teenager, and when he came to see me recently he was also at imminent risk. Eighteen years old, he told me of suicidal thoughts and detailed plans of how he would do it. He told me calmly that he carried a knife and was feeling strong urges to use it against people. He had already made one attempt on his own life, by hanging, and planned on doing it again.

This time I called the Psychiatric Crisis Team – the clue is in the name - to be told that this wasn't a crisis; they wouldn't see him. I was to refer him to the 'personality disorder clinic'. Waiting time? Five months!

So Tony accepted the prescription for mind-numbing drugs I offered him; there was nothing else I could do. Within days he had committed a serious crime on property. He was at risk of imprisonment.

I wrote to his solicitor, stating how harmful a custodial sentence would be. On my next meeting with Tony I told him I would help him avoid prison.

His reaction was surprising and telling. "No one would want to go to prison," he replied, "but at least I'll get some help in there". He was, in effect, committing crime to force his arrest and imprisonment; crying out desperately for help that wasn't coming.

Just as with Sharon, we were failing Tony. Mental health services for young people fall woefully short of the standard they need and deserve. We need to make them better. We'd be mad not to.